<?xml version="1.0"?>
<xs:schema xmlns="http://schemas.microsoft.com/BizTalk/EDI/X12/2006" xmlns:d="urn:schemas-microsoft-com:datatypes" xmlns:b="http://schemas.microsoft.com/BizTalk/2003" xmlns:wpc="http://schemas.wpc-edi.com/X12/ISOMORPH/HIPAA/4010A1" xmlns:btsedi="http://schemas.microsoft.com/BizTalk/2005/EdiSchemaEditorExtension" xmlns:schemaEditorExtension="http://schemas.microsoft.com/BizTalk/2003/SchemaEditorExtensions" targetNamespace="http://schemas.microsoft.com/BizTalk/EDI/X12/2006" version="1.0" xmlns:xs="http://www.w3.org/2001/XMLSchema">
  <xs:annotation>
    <xs:documentation xml:lang="en">  HIPAA Schema TS835W1 - Washington Publishing Company (http://www.wpc-edi.com)</xs:documentation>
    <xs:appinfo>
      <schemaEditorExtension:schemaInfo namespaceAlias="btsedi" extensionClass="Microsoft.BizTalk.Edi.SchemaEditorExtension.EdiSchemaExtension" standardName="EDI" xmlns:schemaEditorExtension="http://schemas.microsoft.com/BizTalk/2003/SchemaEditorExtensions" />
      <b:schemaInfo subdocument_break="yes" BiztalkServerEditorTool_Version="1.5" root_reference="X12_00401_835" displayroot_reference="X12_00401_835" version="3.0" standard="EDI" standards_version="00401" xmlns:b="http://schemas.microsoft.com/BizTalk/2003" X12ConditionDesignator_Check="No" />
    </xs:appinfo>
  </xs:annotation>
  <xs:annotation>
    <xs:documentation xml:lang="en">copyright © Microsoft Corporation. All rights reserved.</xs:documentation>
  </xs:annotation>
  <xs:element name="X12_00401_835">
    <xs:annotation>
      <xs:appinfo>
        <b:recordInfo structure="delimited" delimiter_type="inherit_record" field_order="postfix" count_ignore="yes" notes="Health Care Claim Payment/Advice" />
      </xs:appinfo>
    </xs:annotation>
    <xs:complexType>
      <xs:sequence>
        <xs:element minOccurs="0" name="ST">
          <xs:annotation>
            <xs:appinfo>
              <b:recordInfo notes="Transaction Set Header" />
            </xs:appinfo>
          </xs:annotation>
          <xs:complexType>
            <xs:sequence>
              <xs:element name="ST01">
                <xs:annotation>
                  <xs:appinfo>
                    <b:fieldInfo notes="Transaction Set Identifier Code_143" />
                  </xs:appinfo>
                </xs:annotation>
                <xs:simpleType>
                  <xs:restriction base="X12_AN">
                    <xs:minLength value="3" />
                    <xs:maxLength value="3" />
                  </xs:restriction>
                </xs:simpleType>
              </xs:element>
              <xs:element name="ST02">
                <xs:annotation>
                  <xs:appinfo>
                    <b:fieldInfo notes="Transaction Set Control Number_329" />
                  </xs:appinfo>
                </xs:annotation>
                <xs:simpleType>
                  <xs:restriction base="X12_AN">
                    <xs:minLength value="4" />
                    <xs:maxLength value="9" />
                  </xs:restriction>
                </xs:simpleType>
              </xs:element>
              <xs:element minOccurs="0" name="ST03">
                <xs:annotation>
                  <xs:appinfo>
                    <b:fieldInfo notes="Implementation Convention Preference_1705" />
                  </xs:appinfo>
                </xs:annotation>
                <xs:simpleType>
                  <xs:restriction base="X12_AN">
                    <xs:minLength value="1" />
                    <xs:maxLength value="9" />
                  </xs:restriction>
                </xs:simpleType>
              </xs:element>
            </xs:sequence>
          </xs:complexType>
        </xs:element>
        <xs:element minOccurs="1" maxOccurs="1" ref="BPR_FinancialInformation_TS835W1" />
        <xs:element minOccurs="1" maxOccurs="1" ref="TRN_ReassociationTraceNumber_TS835W1" />
        <xs:element minOccurs="0" maxOccurs="1" ref="CUR_ForeignCurrencyInformation_TS835W1" />
        <xs:element minOccurs="0" maxOccurs="1" ref="REF_ReceiverIdentification_TS835W1" />
        <xs:element minOccurs="0" maxOccurs="1" ref="REF_VersionIdentification_TS835W1" />
        <xs:element minOccurs="0" maxOccurs="1" ref="DTM_ProductionDate_TS835W1" />
        <xs:element minOccurs="1" maxOccurs="1" ref="TS835W1_1000A_Loop" />
        <xs:element minOccurs="1" maxOccurs="1" ref="TS835W1_1000B_Loop" />
        <xs:element minOccurs="0" maxOccurs="unbounded" ref="TS835W1_2000_Loop" />
        <xs:element minOccurs="0" maxOccurs="unbounded" ref="PLB_ProviderAdjustment_TS835W1" />
        <xs:element minOccurs="0" name="SE">
          <xs:annotation>
            <xs:appinfo>
              <b:recordInfo notes="Transaction Set Trailer" />
            </xs:appinfo>
          </xs:annotation>
          <xs:complexType>
            <xs:sequence>
              <xs:element name="SE01">
                <xs:annotation>
                  <xs:appinfo>
                    <b:fieldInfo notes="Number of Included Segments_96" />
                  </xs:appinfo>
                </xs:annotation>
                <xs:simpleType>
                  <xs:restriction base="X12_AN">
                    <xs:minLength value="1" />
                    <xs:maxLength value="10" />
                  </xs:restriction>
                </xs:simpleType>
              </xs:element>
              <xs:element name="SE02">
                <xs:annotation>
                  <xs:appinfo>
                    <b:fieldInfo notes="Transaction Set Control Number_329" />
                  </xs:appinfo>
                </xs:annotation>
                <xs:simpleType>
                  <xs:restriction base="X12_AN">
                    <xs:minLength value="4" />
                    <xs:maxLength value="9" />
                  </xs:restriction>
                </xs:simpleType>
              </xs:element>
            </xs:sequence>
          </xs:complexType>
        </xs:element>
      </xs:sequence>
    </xs:complexType>
  </xs:element>
  <xs:element name="BPR_FinancialInformation_TS835W1">
    <xs:annotation>
      <xs:appinfo>
        <b:recordInfo tag_name="BPR_FinancialInformation_TS835W1" structure="delimited" delimiter_type="inherit_field" field_order="prefix" count_ignore="no" child_delimiter="default" notes="Financial Information">
          <b:Rule subjects="X12ConditionDesignatorX_Paired">
            <b:Subject name="BPR06__DepositoryFinancialInstitutionDFIIdentificationNumberQualifier" />
            <b:Subject name="BPR07__SenderDFIIdentifier" />
          </b:Rule>
          <b:Rule subjects="X12ConditionDesignatorX_Conditional" qualifier="BPR08__AccountNumberQualifier">
            <b:Subject name="BPR09__SenderBankAccountNumber" />
          </b:Rule>
          <b:Rule subjects="X12ConditionDesignatorX_Paired">
            <b:Subject name="BPR12__DepositoryFinancialInstitutionDFIIdentificationNumberQualifier" />
            <b:Subject name="BPR13__ReceiverOrProviderBankIDNumber" />
          </b:Rule>
          <b:Rule subjects="X12ConditionDesignatorX_Conditional" qualifier="BPR14__AccountNumberQualifier">
            <b:Subject name="BPR15__ReceiverOrProviderAccountNumber" />
          </b:Rule>
          <b:Rule subjects="X12ConditionDesignatorX_Paired">
            <b:Subject name="BPR18" />
            <b:Subject name="BPR19" />
          </b:Rule>
          <b:Rule subjects="X12ConditionDesignatorX_Conditional" qualifier="BPR20">
            <b:Subject name="BPR21" />
          </b:Rule>
        </b:recordInfo>
      </xs:appinfo>
    </xs:annotation>
    <xs:complexType>
      <xs:sequence>
        <xs:element name="BPR01__TransactionHandlingCode">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="ID" justification="left" codelist="305" sequence_number="01">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_ID">
              <xs:enumeration value="C" />
              <xs:enumeration value="D" />
              <xs:enumeration value="H" />
              <xs:enumeration value="I" />
              <xs:enumeration value="P" />
              <xs:enumeration value="U" />
              <xs:enumeration value="X" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element name="BPR02__TotalActualProviderPaymentAmount">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo custom_maxlength="18" edi_datatype="R" justification="right" sequence_number="02">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_R" />
          </xs:simpleType>
        </xs:element>
        <xs:element name="BPR03__CreditOrDebitFlagCode">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="ID" codelist="478" sequence_number="03">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_ID">
              <xs:enumeration value="C" />
              <xs:enumeration value="D" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element name="BPR04__PaymentMethodCode">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="ID" codelist="591" sequence_number="04">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_ID">
              <xs:enumeration value="ACH" />
              <xs:enumeration value="BOP" />
              <xs:enumeration value="CHK" />
              <xs:enumeration value="FWT" />
              <xs:enumeration value="NON" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="BPR05__PaymentFormatCode">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="ID" justification="left" codelist="812" sequence_number="05">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_ID">
              <xs:enumeration value="CCP" />
              <xs:enumeration value="CTX" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="BPR06__DepositoryFinancialInstitutionDFIIdentificationNumberQualifier">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="ID" codelist="506" sequence_number="06">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_ID">
              <xs:enumeration value="01" />
              <xs:enumeration value="04" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="BPR07__SenderDFIIdentifier">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="AN" justification="left" sequence_number="07">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_AN">
              <xs:minLength value="3" />
              <xs:maxLength value="12" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="BPR08__AccountNumberQualifier">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="ID" justification="left" codelist="569" sequence_number="08">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_ID">
              <xs:enumeration value="DA" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="BPR09__SenderBankAccountNumber">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="AN" justification="left" sequence_number="09">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_AN">
              <xs:minLength value="1" />
              <xs:maxLength value="35" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="BPR10__PayerIdentifier">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="AN" sequence_number="10">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_AN">
              <xs:minLength value="10" />
              <xs:maxLength value="10" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="BPR11__OriginatingCompanySupplementalCode">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="AN" sequence_number="11">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_AN">
              <xs:minLength value="9" />
              <xs:maxLength value="9" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="BPR12__DepositoryFinancialInstitutionDFIIdentificationNumberQualifier">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="ID" codelist="506" sequence_number="12">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_ID">
              <xs:enumeration value="01" />
              <xs:enumeration value="04" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="BPR13__ReceiverOrProviderBankIDNumber">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="AN" justification="left" sequence_number="13">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_AN">
              <xs:minLength value="3" />
              <xs:maxLength value="12" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="BPR14__AccountNumberQualifier">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="ID" justification="left" codelist="569" sequence_number="14">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_ID">
              <xs:enumeration value="DA" />
              <xs:enumeration value="SG" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="BPR15__ReceiverOrProviderAccountNumber">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="AN" justification="left" sequence_number="15">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_AN">
              <xs:minLength value="1" />
              <xs:maxLength value="35" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element name="BPR16__CheckIssueOrEFTEffectiveDate">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="DT" format="YYYYMMDD" sequence_number="16">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_DT">
              <xs:minLength value="8" />
              <xs:maxLength value="8" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="BPR17">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="ID" justification="left" sequence_number="17">
              </b:fieldInfo>
              <wpc:Info NotUsed="true" xmlns:wpc="http://schemas.wpc-edi.com/X12/ISOMORPH/HIPAA/4010A1" />
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_ID">
              <xs:minLength value="1" />
              <xs:maxLength value="3" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="BPR18">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="ID" sequence_number="18">
              </b:fieldInfo>
              <wpc:Info NotUsed="true" />
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_ID">
              <xs:minLength value="2" />
              <xs:maxLength value="2" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="BPR19">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="AN" justification="left" sequence_number="19">
              </b:fieldInfo>
              <wpc:Info NotUsed="true" />
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_AN">
              <xs:minLength value="3" />
              <xs:maxLength value="12" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="BPR20">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="ID" justification="left" sequence_number="20">
              </b:fieldInfo>
              <wpc:Info NotUsed="true" />
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_ID">
              <xs:minLength value="1" />
              <xs:maxLength value="3" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="BPR21">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="AN" justification="left" sequence_number="21">
              </b:fieldInfo>
              <wpc:Info NotUsed="true" />
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_AN">
              <xs:minLength value="1" />
              <xs:maxLength value="35" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
      </xs:sequence>
    </xs:complexType>
  </xs:element>
  <xs:element name="TRN_ReassociationTraceNumber_TS835W1">
    <xs:annotation>
      <xs:appinfo>
        <b:recordInfo tag_name="TRN_ReassociationTraceNumber_TS835W1" structure="delimited" delimiter_type="inherit_field" field_order="prefix" count_ignore="no" child_delimiter="default" notes="Reassociation Trace Number" />
      </xs:appinfo>
    </xs:annotation>
    <xs:complexType>
      <xs:sequence>
        <xs:element name="TRN01__TraceTypeCode">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="ID" justification="left" codelist="481" sequence_number="01">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_ID">
              <xs:enumeration value="1" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element name="TRN02__CheckOrEFTTraceNumber">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="AN" justification="left" sequence_number="02">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_AN">
              <xs:minLength value="1" />
              <xs:maxLength value="30" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element name="TRN03__PayerIdentifier">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="AN" sequence_number="03">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_AN">
              <xs:minLength value="10" />
              <xs:maxLength value="10" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="TRN04__OriginatingCompanySupplementalCode">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="AN" justification="left" sequence_number="04">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_AN">
              <xs:minLength value="1" />
              <xs:maxLength value="30" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
      </xs:sequence>
    </xs:complexType>
  </xs:element>
  <xs:element name="CUR_ForeignCurrencyInformation_TS835W1">
    <xs:annotation>
      <xs:appinfo>
        <b:recordInfo tag_name="CUR_ForeignCurrencyInformation_TS835W1" structure="delimited" delimiter_type="inherit_field" field_order="prefix" count_ignore="no" child_delimiter="default" notes="Foreign Currency Information">
          <b:Rule subjects="X12ConditionDesignatorX_Conditional" qualifier="CUR08">
            <b:Subject name="CUR07" />
          </b:Rule>
          <b:Rule subjects="X12ConditionDesignatorX_Conditional" qualifier="CUR09">
            <b:Subject name="CUR07" />
          </b:Rule>
          <b:Rule subjects="X12ConditionDesignatorX_ListConditional" qualifier="CUR10">
            <b:Subject name="CUR11" />
            <b:Subject name="CUR12" />
          </b:Rule>
          <b:Rule subjects="X12ConditionDesignatorX_Conditional" qualifier="CUR11">
            <b:Subject name="CUR10" />
          </b:Rule>
          <b:Rule subjects="X12ConditionDesignatorX_Conditional" qualifier="CUR12">
            <b:Subject name="CUR10" />
          </b:Rule>
          <b:Rule subjects="X12ConditionDesignatorX_ListConditional" qualifier="CUR13">
            <b:Subject name="CUR14" />
            <b:Subject name="CUR15" />
          </b:Rule>
          <b:Rule subjects="X12ConditionDesignatorX_Conditional" qualifier="CUR14">
            <b:Subject name="CUR13" />
          </b:Rule>
          <b:Rule subjects="X12ConditionDesignatorX_Conditional" qualifier="CUR15">
            <b:Subject name="CUR13" />
          </b:Rule>
          <b:Rule subjects="X12ConditionDesignatorX_ListConditional" qualifier="CUR16">
            <b:Subject name="CUR17" />
            <b:Subject name="CUR18" />
          </b:Rule>
          <b:Rule subjects="X12ConditionDesignatorX_Conditional" qualifier="CUR17">
            <b:Subject name="CUR16" />
          </b:Rule>
          <b:Rule subjects="X12ConditionDesignatorX_Conditional" qualifier="CUR18">
            <b:Subject name="CUR16" />
          </b:Rule>
          <b:Rule subjects="X12ConditionDesignatorX_ListConditional" qualifier="CUR19">
            <b:Subject name="CUR20" />
            <b:Subject name="CUR21" />
          </b:Rule>
          <b:Rule subjects="X12ConditionDesignatorX_Conditional" qualifier="CUR20">
            <b:Subject name="CUR19" />
          </b:Rule>
          <b:Rule subjects="X12ConditionDesignatorX_Conditional" qualifier="CUR21">
            <b:Subject name="CUR19" />
          </b:Rule>
        </b:recordInfo>
      </xs:appinfo>
    </xs:annotation>
    <xs:complexType>
      <xs:sequence>
        <xs:element name="CUR01__EntityIdentifierCode">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="ID" justification="left" codelist="98" sequence_number="01">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_ID">
              <xs:enumeration value="PR" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element name="CUR02__CurrencyCode">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="ID" sequence_number="02">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_ID">
              <xs:minLength value="3" />
              <xs:maxLength value="3" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="CUR03__ExchangeRate">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo custom_maxlength="10" edi_datatype="R" justification="right" sequence_number="03">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_R" />
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="CUR04">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="ID" justification="left" sequence_number="04">
              </b:fieldInfo>
              <wpc:Info NotUsed="true" />
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_ID">
              <xs:minLength value="2" />
              <xs:maxLength value="3" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="CUR05">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="ID" sequence_number="05">
              </b:fieldInfo>
              <wpc:Info NotUsed="true" />
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_ID">
              <xs:minLength value="3" />
              <xs:maxLength value="3" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="CUR06">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="ID" sequence_number="06">
              </b:fieldInfo>
              <wpc:Info NotUsed="true" />
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_ID">
              <xs:minLength value="3" />
              <xs:maxLength value="3" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="CUR07">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="ID" sequence_number="07">
              </b:fieldInfo>
              <wpc:Info NotUsed="true" />
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_ID">
              <xs:minLength value="3" />
              <xs:maxLength value="3" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="CUR08">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="DT" format="YYYYMMDD" sequence_number="08">
              </b:fieldInfo>
              <wpc:Info NotUsed="true" />
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_DT">
              <xs:minLength value="8" />
              <xs:maxLength value="8" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="CUR09">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="TM" format="HHMMSSDD" sequence_number="09">
              </b:fieldInfo>
              <wpc:Info NotUsed="true" />
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_TM">
              <xs:minLength value="4" />
              <xs:maxLength value="8" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="CUR10">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="ID" sequence_number="10">
              </b:fieldInfo>
              <wpc:Info NotUsed="true" />
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_ID">
              <xs:minLength value="3" />
              <xs:maxLength value="3" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="CUR11">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="DT" format="YYYYMMDD" sequence_number="11">
              </b:fieldInfo>
              <wpc:Info NotUsed="true" />
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_DT">
              <xs:minLength value="8" />
              <xs:maxLength value="8" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="CUR12">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="TM" format="HHMMSSDD" sequence_number="12">
              </b:fieldInfo>
              <wpc:Info NotUsed="true" />
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_TM">
              <xs:minLength value="4" />
              <xs:maxLength value="8" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="CUR13">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="ID" sequence_number="13">
              </b:fieldInfo>
              <wpc:Info NotUsed="true" />
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_ID">
              <xs:minLength value="3" />
              <xs:maxLength value="3" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="CUR14">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="DT" format="YYYYMMDD" sequence_number="14">
              </b:fieldInfo>
              <wpc:Info NotUsed="true" />
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_DT">
              <xs:minLength value="8" />
              <xs:maxLength value="8" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="CUR15">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="TM" format="HHMMSSDD" sequence_number="15">
              </b:fieldInfo>
              <wpc:Info NotUsed="true" />
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_TM">
              <xs:minLength value="4" />
              <xs:maxLength value="8" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="CUR16">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="ID" sequence_number="16">
              </b:fieldInfo>
              <wpc:Info NotUsed="true" />
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_ID">
              <xs:minLength value="3" />
              <xs:maxLength value="3" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="CUR17">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="DT" format="YYYYMMDD" sequence_number="17">
              </b:fieldInfo>
              <wpc:Info NotUsed="true" />
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_DT">
              <xs:minLength value="8" />
              <xs:maxLength value="8" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="CUR18">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="TM" format="HHMMSSDD" sequence_number="18">
              </b:fieldInfo>
              <wpc:Info NotUsed="true" />
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_TM">
              <xs:minLength value="4" />
              <xs:maxLength value="8" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="CUR19">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="ID" sequence_number="19">
              </b:fieldInfo>
              <wpc:Info NotUsed="true" />
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_ID">
              <xs:minLength value="3" />
              <xs:maxLength value="3" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="CUR20">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="DT" format="YYYYMMDD" sequence_number="20">
              </b:fieldInfo>
              <wpc:Info NotUsed="true" />
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_DT">
              <xs:minLength value="8" />
              <xs:maxLength value="8" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="CUR21">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="TM" format="HHMMSSDD" sequence_number="21">
              </b:fieldInfo>
              <wpc:Info NotUsed="true" />
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_TM">
              <xs:minLength value="4" />
              <xs:maxLength value="8" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
      </xs:sequence>
    </xs:complexType>
  </xs:element>
  <xs:element name="REF_ReceiverIdentification_TS835W1">
    <xs:annotation>
      <xs:appinfo>
        <b:recordInfo trigger_field="REF01__ReferenceIdentificationQualifier" trigger_value="EV" tag_name="REF_ReceiverIdentification_TS835W1" structure="delimited" delimiter_type="inherit_field" field_order="prefix" count_ignore="no" child_delimiter="default" notes="Receiver Identification">
          <b:Rule subjects="X12ConditionDesignatorX_Required">
            <b:Subject name="REF02__ReceiverIdentifier" />
            <b:Subject name="REF03" />
          </b:Rule>
        </b:recordInfo>
      </xs:appinfo>
    </xs:annotation>
    <xs:complexType>
      <xs:sequence>
        <xs:element name="REF01__ReferenceIdentificationQualifier">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="ID" justification="left" codelist="128" sequence_number="01">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_ID">
              <xs:enumeration value="EV" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element name="REF02__ReceiverIdentifier">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="AN" justification="left" sequence_number="02">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_AN">
              <xs:minLength value="1" />
              <xs:maxLength value="30" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="REF03">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="AN" justification="left" sequence_number="03">
              </b:fieldInfo>
              <wpc:Info NotUsed="true" />
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_AN">
              <xs:minLength value="1" />
              <xs:maxLength value="80" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="REF04_C040U782">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="AN" sequence_number="04">
              </b:fieldInfo>
              <wpc:Info NotUsed="true" />
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_AN">
              <xs:minLength value="1" />
              <xs:maxLength value="1" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
      </xs:sequence>
    </xs:complexType>
  </xs:element>
  <xs:element name="REF_VersionIdentification_TS835W1">
    <xs:annotation>
      <xs:appinfo>
        <b:recordInfo trigger_field="REF01__ReferenceIdentificationQualifier" trigger_value="F2" tag_name="REF_VersionIdentification_TS835W1" structure="delimited" delimiter_type="inherit_field" field_order="prefix" count_ignore="no" child_delimiter="default" notes="Version Identification">
          <b:Rule subjects="X12ConditionDesignatorX_Required">
            <b:Subject name="REF02__VersionIdentificationCode" />
            <b:Subject name="REF03" />
          </b:Rule>
        </b:recordInfo>
      </xs:appinfo>
    </xs:annotation>
    <xs:complexType>
      <xs:sequence>
        <xs:element name="REF01__ReferenceIdentificationQualifier">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="ID" justification="left" codelist="128" sequence_number="01">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_ID">
              <xs:enumeration value="F2" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element name="REF02__VersionIdentificationCode">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="AN" justification="left" sequence_number="02">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_AN">
              <xs:minLength value="1" />
              <xs:maxLength value="30" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="REF03">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="AN" justification="left" sequence_number="03">
              </b:fieldInfo>
              <wpc:Info NotUsed="true" />
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_AN">
              <xs:minLength value="1" />
              <xs:maxLength value="80" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="REF04_C040U783">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="AN" sequence_number="04">
              </b:fieldInfo>
              <wpc:Info NotUsed="true" />
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_AN">
              <xs:minLength value="1" />
              <xs:maxLength value="1" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
      </xs:sequence>
    </xs:complexType>
  </xs:element>
  <xs:element name="DTM_ProductionDate_TS835W1">
    <xs:annotation>
      <xs:appinfo>
        <b:recordInfo tag_name="DTM_ProductionDate_TS835W1" structure="delimited" delimiter_type="inherit_field" field_order="prefix" count_ignore="no" child_delimiter="default" notes="Production Date">
          <b:Rule subjects="X12ConditionDesignatorX_Required">
            <b:Subject name="DTM02__ProductionDate" />
            <b:Subject name="DTM03" />
            <b:Subject name="DTM05" />
          </b:Rule>
          <b:Rule subjects="X12ConditionDesignatorX_Conditional" qualifier="DTM04">
            <b:Subject name="DTM03" />
          </b:Rule>
          <b:Rule subjects="X12ConditionDesignatorX_Paired">
            <b:Subject name="DTM05" />
            <b:Subject name="DTM06" />
          </b:Rule>
        </b:recordInfo>
      </xs:appinfo>
    </xs:annotation>
    <xs:complexType>
      <xs:sequence>
        <xs:element name="DTM01__DateTimeQualifier">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="ID" codelist="374" sequence_number="01">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_ID">
              <xs:enumeration value="405" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element name="DTM02__ProductionDate">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="DT" format="YYYYMMDD" sequence_number="02">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_DT">
              <xs:minLength value="8" />
              <xs:maxLength value="8" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="DTM03">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="TM" format="HHMMSSDD" sequence_number="03">
              </b:fieldInfo>
              <wpc:Info NotUsed="true" />
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_TM">
              <xs:minLength value="4" />
              <xs:maxLength value="8" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="DTM04">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="ID" sequence_number="04">
              </b:fieldInfo>
              <wpc:Info NotUsed="true" />
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_ID">
              <xs:minLength value="2" />
              <xs:maxLength value="2" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="DTM05">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="ID" justification="left" sequence_number="05">
              </b:fieldInfo>
              <wpc:Info NotUsed="true" />
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_ID">
              <xs:minLength value="2" />
              <xs:maxLength value="3" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="DTM06">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="AN" justification="left" sequence_number="06">
              </b:fieldInfo>
              <wpc:Info NotUsed="true" />
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_AN">
              <xs:minLength value="1" />
              <xs:maxLength value="35" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
      </xs:sequence>
    </xs:complexType>
  </xs:element>
  <xs:element name="TS835W1_1000A_Loop">
    <xs:annotation>
      <xs:appinfo>
        <b:recordInfo structure="delimited" delimiter_type="inherit_record" field_order="infix" count_ignore="yes" child_delimiter="default" trigger_field="N1_PayerIdentification_TS835W1_1000A/N101__EntityIdentifierCode" trigger_value="PR" notes="Payer Identification" />
      </xs:appinfo>
    </xs:annotation>
    <xs:complexType>
      <xs:sequence>
        <xs:element minOccurs="1" maxOccurs="1" ref="N1_PayerIdentification_TS835W1_1000A" />
        <xs:element minOccurs="1" maxOccurs="1" ref="N3_PayerAddress_TS835W1_1000A" />
        <xs:element minOccurs="1" maxOccurs="1" ref="N4_PayerCityStateZIPCode_TS835W1_1000A" />
        <xs:element minOccurs="0" maxOccurs="4" ref="REF_AdditionalPayerIdentification_TS835W1_1000A" />
        <xs:element minOccurs="0" maxOccurs="1" ref="PER_PayerContactInformation_TS835W1_1000A" />
      </xs:sequence>
    </xs:complexType>
  </xs:element>
  <xs:element name="N1_PayerIdentification_TS835W1_1000A">
    <xs:annotation>
      <xs:appinfo>
        <b:recordInfo tag_name="N1_PayerIdentification_TS835W1_1000A" structure="delimited" delimiter_type="inherit_field" field_order="prefix" count_ignore="no" child_delimiter="default" notes="Payer Identification">
          <b:Rule subjects="X12ConditionDesignatorX_Required">
            <b:Subject name="N102__PayerName" />
            <b:Subject name="N103__IdentificationCodeQualifier" />
          </b:Rule>
          <b:Rule subjects="X12ConditionDesignatorX_Paired">
            <b:Subject name="N103__IdentificationCodeQualifier" />
            <b:Subject name="N104__PayerIdentifier" />
          </b:Rule>
        </b:recordInfo>
      </xs:appinfo>
    </xs:annotation>
    <xs:complexType>
      <xs:sequence>
        <xs:element name="N101__EntityIdentifierCode">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="ID" justification="left" codelist="98" sequence_number="01">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_ID">
              <xs:enumeration value="PR" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="N102__PayerName">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="AN" justification="left" sequence_number="02">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_AN">
              <xs:minLength value="1" />
              <xs:maxLength value="60" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="N103__IdentificationCodeQualifier">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="ID" justification="left" codelist="66" sequence_number="03">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_ID">
              <xs:enumeration value="XV" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="N104__PayerIdentifier">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="AN" justification="left" sequence_number="04">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_AN">
              <xs:minLength value="2" />
              <xs:maxLength value="80" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="N105">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="ID" sequence_number="05">
              </b:fieldInfo>
              <wpc:Info NotUsed="true" />
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_ID">
              <xs:minLength value="2" />
              <xs:maxLength value="2" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="N106">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="ID" justification="left" sequence_number="06">
              </b:fieldInfo>
              <wpc:Info NotUsed="true" />
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_ID">
              <xs:minLength value="2" />
              <xs:maxLength value="3" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
      </xs:sequence>
    </xs:complexType>
  </xs:element>
  <xs:element name="N3_PayerAddress_TS835W1_1000A">
    <xs:annotation>
      <xs:appinfo>
        <b:recordInfo tag_name="N3_PayerAddress_TS835W1_1000A" structure="delimited" delimiter_type="inherit_field" field_order="prefix" count_ignore="no" child_delimiter="default" notes="Payer Address" />
      </xs:appinfo>
    </xs:annotation>
    <xs:complexType>
      <xs:sequence>
        <xs:element name="N301__PayerAddressLine">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="AN" justification="left" sequence_number="01">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_AN">
              <xs:minLength value="1" />
              <xs:maxLength value="55" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="N302__PayerAddressLine">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="AN" justification="left" sequence_number="02">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_AN">
              <xs:minLength value="1" />
              <xs:maxLength value="55" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
      </xs:sequence>
    </xs:complexType>
  </xs:element>
  <xs:element name="N4_PayerCityStateZIPCode_TS835W1_1000A">
    <xs:annotation>
      <xs:appinfo>
        <b:recordInfo tag_name="N4_PayerCityStateZIPCode_TS835W1_1000A" structure="delimited" delimiter_type="inherit_field" field_order="prefix" count_ignore="no" child_delimiter="default" notes="Payer City, State, ZIP Code">
          <b:Rule subjects="X12ConditionDesignatorX_Conditional" qualifier="N406">
            <b:Subject name="N405" />
          </b:Rule>
        </b:recordInfo>
      </xs:appinfo>
    </xs:annotation>
    <xs:complexType>
      <xs:sequence>
        <xs:element name="N401__PayerCityName">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="AN" justification="left" sequence_number="01">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_AN">
              <xs:minLength value="2" />
              <xs:maxLength value="30" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element name="N402__PayerStateCode">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="ID" sequence_number="02">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_ID">
              <xs:minLength value="2" />
              <xs:maxLength value="2" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element name="N403__PayerPostalZoneOrZIPCode">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="ID" justification="left" sequence_number="03">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_ID">
              <xs:minLength value="3" />
              <xs:maxLength value="15" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="N404">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="ID" justification="left" sequence_number="04">
              </b:fieldInfo>
              <wpc:Info NotUsed="true" />
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_ID">
              <xs:minLength value="2" />
              <xs:maxLength value="3" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="N405">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="ID" justification="left" sequence_number="05">
              </b:fieldInfo>
              <wpc:Info NotUsed="true" />
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_ID">
              <xs:minLength value="1" />
              <xs:maxLength value="2" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="N406">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="AN" justification="left" sequence_number="06">
              </b:fieldInfo>
              <wpc:Info NotUsed="true" />
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_AN">
              <xs:minLength value="1" />
              <xs:maxLength value="30" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
      </xs:sequence>
    </xs:complexType>
  </xs:element>
  <xs:element name="REF_AdditionalPayerIdentification_TS835W1_1000A">
    <xs:annotation>
      <xs:appinfo>
        <b:recordInfo tag_name="REF_AdditionalPayerIdentification_TS835W1_1000A" structure="delimited" delimiter_type="inherit_field" field_order="prefix" count_ignore="no" child_delimiter="default" notes="Additional Payer Identification">
          <b:Rule subjects="X12ConditionDesignatorX_Required">
            <b:Subject name="REF02__AdditionalPayerIdentifier" />
            <b:Subject name="REF03" />
          </b:Rule>
        </b:recordInfo>
      </xs:appinfo>
    </xs:annotation>
    <xs:complexType>
      <xs:sequence>
        <xs:element name="REF01__ReferenceIdentificationQualifier">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="ID" justification="left" codelist="128" sequence_number="01">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_ID">
              <xs:enumeration value="2U" />
              <xs:enumeration value="EO" />
              <xs:enumeration value="HI" />
              <xs:enumeration value="NF" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element name="REF02__AdditionalPayerIdentifier">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="AN" justification="left" sequence_number="02">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_AN">
              <xs:minLength value="1" />
              <xs:maxLength value="30" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="REF03">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="AN" justification="left" sequence_number="03">
              </b:fieldInfo>
              <wpc:Info NotUsed="true" />
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_AN">
              <xs:minLength value="1" />
              <xs:maxLength value="80" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="REF04_C040U784">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="AN" sequence_number="04">
              </b:fieldInfo>
              <wpc:Info NotUsed="true" />
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_AN">
              <xs:minLength value="1" />
              <xs:maxLength value="1" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
      </xs:sequence>
    </xs:complexType>
  </xs:element>
  <xs:element name="PER_PayerContactInformation_TS835W1_1000A">
    <xs:annotation>
      <xs:appinfo>
        <b:recordInfo tag_name="PER_PayerContactInformation_TS835W1_1000A" structure="delimited" delimiter_type="inherit_field" field_order="prefix" count_ignore="no" child_delimiter="default" notes="Payer Contact Information">
          <b:Rule subjects="X12ConditionDesignatorX_Paired">
            <b:Subject name="PER03__CommunicationNumberQualifier" />
            <b:Subject name="PER04__PayerContactCommunicationNumber" />
          </b:Rule>
          <b:Rule subjects="X12ConditionDesignatorX_Paired">
            <b:Subject name="PER05__CommunicationNumberQualifier" />
            <b:Subject name="PER06__PayerContactCommunicationNumber" />
          </b:Rule>
          <b:Rule subjects="X12ConditionDesignatorX_Paired">
            <b:Subject name="PER07__CommunicationNumberQualifier" />
            <b:Subject name="PER08__PayerContactCommunicationNumber" />
          </b:Rule>
        </b:recordInfo>
      </xs:appinfo>
    </xs:annotation>
    <xs:complexType>
      <xs:sequence>
        <xs:element name="PER01__ContactFunctionCode">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="ID" codelist="366" sequence_number="01">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_ID">
              <xs:enumeration value="CX" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="PER02__PayerContactName">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="AN" justification="left" sequence_number="02">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_AN">
              <xs:minLength value="1" />
              <xs:maxLength value="60" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="PER03__CommunicationNumberQualifier">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="ID" codelist="365" sequence_number="03">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_ID">
              <xs:enumeration value="EM" />
              <xs:enumeration value="FX" />
              <xs:enumeration value="TE" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="PER04__PayerContactCommunicationNumber">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="AN" justification="left" sequence_number="04">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_AN">
              <xs:minLength value="1" />
              <xs:maxLength value="80" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="PER05__CommunicationNumberQualifier">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="ID" codelist="365" sequence_number="05">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_ID">
              <xs:enumeration value="EM" />
              <xs:enumeration value="EX" />
              <xs:enumeration value="FX" />
              <xs:enumeration value="TE" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="PER06__PayerContactCommunicationNumber">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="AN" justification="left" sequence_number="06">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_AN">
              <xs:minLength value="1" />
              <xs:maxLength value="80" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="PER07__CommunicationNumberQualifier">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="ID" codelist="365" sequence_number="07">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_ID">
              <xs:enumeration value="EX" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="PER08__PayerContactCommunicationNumber">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="AN" justification="left" sequence_number="08">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_AN">
              <xs:minLength value="1" />
              <xs:maxLength value="80" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="PER09">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="AN" justification="left" sequence_number="09">
              </b:fieldInfo>
              <wpc:Info NotUsed="true" />
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_AN">
              <xs:minLength value="1" />
              <xs:maxLength value="20" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
      </xs:sequence>
    </xs:complexType>
  </xs:element>
  <xs:element name="TS835W1_1000B_Loop">
    <xs:annotation>
      <xs:appinfo>
        <b:recordInfo structure="delimited" delimiter_type="inherit_record" field_order="infix" count_ignore="yes" child_delimiter="default" trigger_field="N1_PayeeIdentification_TS835W1_1000B/N101__EntityIdentifierCode" trigger_value="PE" notes="Payee Identification" />
      </xs:appinfo>
    </xs:annotation>
    <xs:complexType>
      <xs:sequence>
        <xs:element minOccurs="1" maxOccurs="1" ref="N1_PayeeIdentification_TS835W1_1000B" />
        <xs:element minOccurs="0" maxOccurs="1" ref="N3_PayeeAddress_TS835W1_1000B" />
        <xs:element minOccurs="0" maxOccurs="1" ref="N4_PayeeCityStateZIPCode_TS835W1_1000B" />
        <xs:element minOccurs="0" maxOccurs="unbounded" ref="REF_PayeeAdditionalIdentification_TS835W1_1000B" />
      </xs:sequence>
    </xs:complexType>
  </xs:element>
  <xs:element name="N1_PayeeIdentification_TS835W1_1000B">
    <xs:annotation>
      <xs:appinfo>
        <b:recordInfo tag_name="N1_PayeeIdentification_TS835W1_1000B" structure="delimited" delimiter_type="inherit_field" field_order="prefix" count_ignore="no" child_delimiter="default" notes="Payee Identification">
          <b:Rule subjects="X12ConditionDesignatorX_Required">
            <b:Subject name="N102__PayeeName" />
            <b:Subject name="N103__IdentificationCodeQualifier" />
          </b:Rule>
          <b:Rule subjects="X12ConditionDesignatorX_Paired">
            <b:Subject name="N103__IdentificationCodeQualifier" />
            <b:Subject name="N104__PayeeIdentificationCode" />
          </b:Rule>
        </b:recordInfo>
      </xs:appinfo>
    </xs:annotation>
    <xs:complexType>
      <xs:sequence>
        <xs:element name="N101__EntityIdentifierCode">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="ID" justification="left" codelist="98" sequence_number="01">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_ID">
              <xs:enumeration value="PE" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="N102__PayeeName">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="AN" justification="left" sequence_number="02">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_AN">
              <xs:minLength value="1" />
              <xs:maxLength value="60" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element name="N103__IdentificationCodeQualifier">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="ID" justification="left" codelist="66" sequence_number="03">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_ID">
              <xs:enumeration value="FI" />
              <xs:enumeration value="XX" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element name="N104__PayeeIdentificationCode">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="AN" justification="left" sequence_number="04">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_AN">
              <xs:minLength value="2" />
              <xs:maxLength value="80" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="N105">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="ID" sequence_number="05">
              </b:fieldInfo>
              <wpc:Info NotUsed="true" />
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_ID">
              <xs:minLength value="2" />
              <xs:maxLength value="2" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="N106">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="ID" justification="left" sequence_number="06">
              </b:fieldInfo>
              <wpc:Info NotUsed="true" />
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_ID">
              <xs:minLength value="2" />
              <xs:maxLength value="3" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
      </xs:sequence>
    </xs:complexType>
  </xs:element>
  <xs:element name="N3_PayeeAddress_TS835W1_1000B">
    <xs:annotation>
      <xs:appinfo>
        <b:recordInfo tag_name="N3_PayeeAddress_TS835W1_1000B" structure="delimited" delimiter_type="inherit_field" field_order="prefix" count_ignore="no" child_delimiter="default" notes="Payee Address" />
      </xs:appinfo>
    </xs:annotation>
    <xs:complexType>
      <xs:sequence>
        <xs:element name="N301__PayeeAddressLine">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="AN" justification="left" sequence_number="01">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_AN">
              <xs:minLength value="1" />
              <xs:maxLength value="55" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="N302__PayeeAddressLine">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="AN" justification="left" sequence_number="02">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_AN">
              <xs:minLength value="1" />
              <xs:maxLength value="55" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
      </xs:sequence>
    </xs:complexType>
  </xs:element>
  <xs:element name="N4_PayeeCityStateZIPCode_TS835W1_1000B">
    <xs:annotation>
      <xs:appinfo>
        <b:recordInfo tag_name="N4_PayeeCityStateZIPCode_TS835W1_1000B" structure="delimited" delimiter_type="inherit_field" field_order="prefix" count_ignore="no" child_delimiter="default" notes="Payee City, State, ZIP Code">
          <b:Rule subjects="X12ConditionDesignatorX_Conditional" qualifier="N406">
            <b:Subject name="N405" />
          </b:Rule>
        </b:recordInfo>
      </xs:appinfo>
    </xs:annotation>
    <xs:complexType>
      <xs:sequence>
        <xs:element name="N401__PayeeCityName">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="AN" justification="left" sequence_number="01">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_AN">
              <xs:minLength value="2" />
              <xs:maxLength value="30" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element name="N402__PayeeStateCode">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="ID" sequence_number="02">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_ID">
              <xs:minLength value="2" />
              <xs:maxLength value="2" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element name="N403__PayeePostalZoneOrZIPCode">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="ID" justification="left" sequence_number="03">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_ID">
              <xs:minLength value="3" />
              <xs:maxLength value="15" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="N404__CountryCode">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="ID" justification="left" sequence_number="04">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_ID">
              <xs:minLength value="2" />
              <xs:maxLength value="3" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="N405">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="ID" justification="left" sequence_number="05">
              </b:fieldInfo>
              <wpc:Info NotUsed="true" />
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_ID">
              <xs:minLength value="1" />
              <xs:maxLength value="2" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="N406">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="AN" justification="left" sequence_number="06">
              </b:fieldInfo>
              <wpc:Info NotUsed="true" />
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_AN">
              <xs:minLength value="1" />
              <xs:maxLength value="30" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
      </xs:sequence>
    </xs:complexType>
  </xs:element>
  <xs:element name="REF_PayeeAdditionalIdentification_TS835W1_1000B">
    <xs:annotation>
      <xs:appinfo>
        <b:recordInfo tag_name="REF_PayeeAdditionalIdentification_TS835W1_1000B" structure="delimited" delimiter_type="inherit_field" field_order="prefix" count_ignore="no" child_delimiter="default" notes="Payee Additional Identification">
          <b:Rule subjects="X12ConditionDesignatorX_Required">
            <b:Subject name="REF02__AdditionalPayeeIdentifier" />
            <b:Subject name="REF03" />
          </b:Rule>
        </b:recordInfo>
      </xs:appinfo>
    </xs:annotation>
    <xs:complexType>
      <xs:sequence>
        <xs:element name="REF01__ReferenceIdentificationQualifier">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="ID" justification="left" codelist="128" sequence_number="01">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_ID">
              <xs:enumeration value="0B" />
              <xs:enumeration value="1A" />
              <xs:enumeration value="1B" />
              <xs:enumeration value="1C" />
              <xs:enumeration value="1D" />
              <xs:enumeration value="1E" />
              <xs:enumeration value="1F" />
              <xs:enumeration value="1G" />
              <xs:enumeration value="1H" />
              <xs:enumeration value="D3" />
              <xs:enumeration value="G2" />
              <xs:enumeration value="N5" />
              <xs:enumeration value="PQ" />
              <xs:enumeration value="TJ" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element name="REF02__AdditionalPayeeIdentifier">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="AN" justification="left" sequence_number="02">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_AN">
              <xs:minLength value="1" />
              <xs:maxLength value="30" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="REF03">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="AN" justification="left" sequence_number="03">
              </b:fieldInfo>
              <wpc:Info NotUsed="true" />
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_AN">
              <xs:minLength value="1" />
              <xs:maxLength value="80" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="REF04_C040U785">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="AN" sequence_number="04">
              </b:fieldInfo>
              <wpc:Info NotUsed="true" />
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_AN">
              <xs:minLength value="1" />
              <xs:maxLength value="1" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
      </xs:sequence>
    </xs:complexType>
  </xs:element>
  <xs:element name="TS835W1_2000_Loop">
    <xs:annotation>
      <xs:appinfo>
        <b:recordInfo structure="delimited" delimiter_type="inherit_record" field_order="infix" count_ignore="yes" child_delimiter="default" subdocument_creation_break="yes" notes="Header Number" />
      </xs:appinfo>
    </xs:annotation>
    <xs:complexType>
      <xs:sequence>
        <xs:element minOccurs="1" maxOccurs="1" ref="LX_HeaderNumber_TS835W1_2000" />
        <xs:element minOccurs="0" maxOccurs="1" ref="TS3_ProviderSummaryInformation_TS835W1_2000" />
        <xs:element minOccurs="0" maxOccurs="1" ref="TS2_ProviderSupplementalSummaryInformation_TS835W1_2000" />
        <xs:element minOccurs="1" maxOccurs="unbounded" ref="TS835W1_2100_Loop" />
      </xs:sequence>
    </xs:complexType>
  </xs:element>
  <xs:element name="LX_HeaderNumber_TS835W1_2000">
    <xs:annotation>
      <xs:appinfo>
        <b:recordInfo tag_name="LX_HeaderNumber_TS835W1_2000" structure="delimited" delimiter_type="inherit_field" field_order="prefix" count_ignore="no" child_delimiter="default" notes="Header Number" />
      </xs:appinfo>
    </xs:annotation>
    <xs:complexType>
      <xs:sequence>
        <xs:element name="LX01__AssignedNumber">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo custom_maxlength="6" edi_datatype="N0" justification="right" sequence_number="01">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_N0" />
          </xs:simpleType>
        </xs:element>
      </xs:sequence>
    </xs:complexType>
  </xs:element>
  <xs:element name="TS3_ProviderSummaryInformation_TS835W1_2000">
    <xs:annotation>
      <xs:appinfo>
        <b:recordInfo tag_name="TS3_ProviderSummaryInformation_TS835W1_2000" structure="delimited" delimiter_type="inherit_field" field_order="prefix" count_ignore="no" child_delimiter="default" notes="Provider Summary Information" />
      </xs:appinfo>
    </xs:annotation>
    <xs:complexType>
      <xs:sequence>
        <xs:element name="TS301__ProviderIdentifier">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="AN" justification="left" sequence_number="01">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_AN">
              <xs:minLength value="1" />
              <xs:maxLength value="30" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element name="TS302__FacilityTypeCode">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="AN" justification="left" sequence_number="02">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_AN">
              <xs:minLength value="1" />
              <xs:maxLength value="2" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element name="TS303__FiscalPeriodDate">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="DT" format="YYYYMMDD" sequence_number="03">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_DT">
              <xs:minLength value="8" />
              <xs:maxLength value="8" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element name="TS304__TotalClaimCount">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo custom_maxlength="15" edi_datatype="R" justification="right" sequence_number="04">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_R" />
          </xs:simpleType>
        </xs:element>
        <xs:element name="TS305__TotalClaimChargeAmount">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo custom_maxlength="18" edi_datatype="R" justification="right" sequence_number="05">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_R" />
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="TS306__TotalCoveredChargeAmount">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo custom_maxlength="18" edi_datatype="R" justification="right" sequence_number="06">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_R" />
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="TS307__TotalNoncoveredChargeAmount">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo custom_maxlength="18" edi_datatype="R" justification="right" sequence_number="07">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_R" />
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="TS308__TotalDeniedChargeAmount">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo custom_maxlength="18" edi_datatype="R" justification="right" sequence_number="08">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_R" />
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="TS309__TotalProviderPaymentAmount">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo custom_maxlength="18" edi_datatype="R" justification="right" sequence_number="09">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_R" />
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="TS310__TotalInterestAmount">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo custom_maxlength="18" edi_datatype="R" justification="right" sequence_number="10">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_R" />
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="TS311__TotalContractualAdjustmentAmount">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo custom_maxlength="18" edi_datatype="R" justification="right" sequence_number="11">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_R" />
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="TS312__TotalGrammRudmanReductionAmount">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo custom_maxlength="18" edi_datatype="R" justification="right" sequence_number="12">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_R" />
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="TS313__TotalMSPPayerAmount">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo custom_maxlength="18" edi_datatype="R" justification="right" sequence_number="13">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_R" />
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="TS314__TotalBloodDeductibleAmount">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo custom_maxlength="18" edi_datatype="R" justification="right" sequence_number="14">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_R" />
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="TS315__TotalNonLabChargeAmount">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo custom_maxlength="18" edi_datatype="R" justification="right" sequence_number="15">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_R" />
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="TS316__TotalCoinsuranceAmount">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo custom_maxlength="18" edi_datatype="R" justification="right" sequence_number="16">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_R" />
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="TS317__TotalHCPCSReportedChargeAmount">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo custom_maxlength="18" edi_datatype="R" justification="right" sequence_number="17">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_R" />
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="TS318__TotalHCPCSPayableAmount">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo custom_maxlength="18" edi_datatype="R" justification="right" sequence_number="18">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_R" />
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="TS319__TotalDeductibleAmount">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo custom_maxlength="18" edi_datatype="R" justification="right" sequence_number="19">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_R" />
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="TS320__TotalProfessionalComponentAmount">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo custom_maxlength="18" edi_datatype="R" justification="right" sequence_number="20">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_R" />
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="TS321__TotalMSPPatientLiabilityMetAmount">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo custom_maxlength="18" edi_datatype="R" justification="right" sequence_number="21">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_R" />
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="TS322__TotalPatientReimbursementAmount">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo custom_maxlength="18" edi_datatype="R" justification="right" sequence_number="22">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_R" />
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="TS323__TotalPIPClaimCount">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo custom_maxlength="15" edi_datatype="R" justification="right" sequence_number="23">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_R" />
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="TS324__TotalPIPAdjustmentAmount">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo custom_maxlength="18" edi_datatype="R" justification="right" sequence_number="24">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_R" />
          </xs:simpleType>
        </xs:element>
      </xs:sequence>
    </xs:complexType>
  </xs:element>
  <xs:element name="TS2_ProviderSupplementalSummaryInformation_TS835W1_2000">
    <xs:annotation>
      <xs:appinfo>
        <b:recordInfo tag_name="TS2_ProviderSupplementalSummaryInformation_TS835W1_2000" structure="delimited" delimiter_type="inherit_field" field_order="prefix" count_ignore="no" child_delimiter="default" notes="Provider Supplemental Summary Information" />
      </xs:appinfo>
    </xs:annotation>
    <xs:complexType>
      <xs:sequence>
        <xs:element minOccurs="0" name="TS201__TotalDRGAmount">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo custom_maxlength="18" edi_datatype="R" justification="right" sequence_number="01">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_R" />
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="TS202__TotalFederalSpecificAmount">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo custom_maxlength="18" edi_datatype="R" justification="right" sequence_number="02">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_R" />
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="TS203__TotalHospitalSpecificAmount">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo custom_maxlength="18" edi_datatype="R" justification="right" sequence_number="03">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_R" />
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="TS204__TotalDisproportionateShareAmount">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo custom_maxlength="18" edi_datatype="R" justification="right" sequence_number="04">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_R" />
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="TS205__TotalCapitalAmount">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo custom_maxlength="18" edi_datatype="R" justification="right" sequence_number="05">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_R" />
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="TS206__TotalIndirectMedicalEducationAmount">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo custom_maxlength="18" edi_datatype="R" justification="right" sequence_number="06">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_R" />
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="TS207__TotalOutlierDayCount">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo custom_maxlength="15" edi_datatype="R" justification="right" sequence_number="07">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_R" />
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="TS208__TotalDayOutlierAmount">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo custom_maxlength="18" edi_datatype="R" justification="right" sequence_number="08">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_R" />
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="TS209__TotalCostOutlierAmount">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo custom_maxlength="18" edi_datatype="R" justification="right" sequence_number="09">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_R" />
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="TS210__AverageDRGLengthOfStay">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo custom_maxlength="15" edi_datatype="R" justification="right" sequence_number="10">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_R" />
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="TS211__TotalDischargeCount">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo custom_maxlength="15" edi_datatype="R" justification="right" sequence_number="11">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_R" />
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="TS212__TotalCostReportDayCount">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo custom_maxlength="15" edi_datatype="R" justification="right" sequence_number="12">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_R" />
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="TS213__TotalCoveredDayCount">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo custom_maxlength="15" edi_datatype="R" justification="right" sequence_number="13">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_R" />
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="TS214__TotalNoncoveredDayCount">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo custom_maxlength="15" edi_datatype="R" justification="right" sequence_number="14">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_R" />
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="TS215__TotalMSPPassThroughAmount">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo custom_maxlength="18" edi_datatype="R" justification="right" sequence_number="15">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_R" />
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="TS216__AverageDRGWeight">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo custom_maxlength="15" edi_datatype="R" justification="right" sequence_number="16">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_R" />
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="TS217__TotalPPSCapitalFSPDRGAmount">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo custom_maxlength="18" edi_datatype="R" justification="right" sequence_number="17">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_R" />
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="TS218__TotalPPSCapitalHSPDRGAmount">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo custom_maxlength="18" edi_datatype="R" justification="right" sequence_number="18">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_R" />
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="TS219__TotalPPSDSHDRGAmount">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo custom_maxlength="18" edi_datatype="R" justification="right" sequence_number="19">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_R" />
          </xs:simpleType>
        </xs:element>
      </xs:sequence>
    </xs:complexType>
  </xs:element>
  <xs:element name="TS835W1_2100_Loop">
    <xs:annotation>
      <xs:appinfo>
        <b:recordInfo structure="delimited" delimiter_type="inherit_record" field_order="infix" count_ignore="yes" child_delimiter="default" notes="Claim Payment Information" />
      </xs:appinfo>
    </xs:annotation>
    <xs:complexType>
      <xs:sequence>
        <xs:element minOccurs="1" maxOccurs="1" ref="CLP_ClaimPaymentInformation_TS835W1_2100" />
        <xs:element minOccurs="0" maxOccurs="99" ref="CAS_ClaimAdjustment_TS835W1_2100" />
        <xs:element minOccurs="1" maxOccurs="1" ref="NM1_PatientName_TS835W1_2100" />
        <xs:element minOccurs="0" maxOccurs="1" ref="NM1_InsuredName_TS835W1_2100" />
        <xs:element minOccurs="0" maxOccurs="1" ref="NM1_CorrectedPatientInsuredName_TS835W1_2100" />
        <xs:element minOccurs="0" maxOccurs="1" ref="NM1_ServiceProviderName_TS835W1_2100" />
        <xs:element minOccurs="0" maxOccurs="1" ref="NM1_CrossoverCarrierName_TS835W1_2100" />
        <xs:element minOccurs="0" maxOccurs="2" ref="NM1_CorrectedPriorityPayerName_TS835W1_2100" />
        <xs:element minOccurs="0" maxOccurs="1" ref="MIA_InpatientAdjudicationInformation_TS835W1_2100" />
        <xs:element minOccurs="0" maxOccurs="1" ref="MOA_OutpatientAdjudicationInformation_TS835W1_2100" />
        <xs:element minOccurs="0" maxOccurs="5" ref="REF_OtherClaimRelatedIdentification_TS835W1_2100" />
        <xs:element minOccurs="0" maxOccurs="10" ref="REF_RenderingProviderIdentification_TS835W1_2100" />
        <xs:element minOccurs="0" maxOccurs="4" ref="DTM_ClaimDate_TS835W1_2100" />
        <xs:element minOccurs="0" maxOccurs="3" ref="PER_ClaimContactInformation_TS835W1_2100" />
        <xs:element minOccurs="0" maxOccurs="14" ref="AMT_ClaimSupplementalInformation_TS835W1_2100" />
        <xs:element minOccurs="0" maxOccurs="15" ref="QTY_ClaimSupplementalInformationQuantity_TS835W1_2100" />
        <xs:element minOccurs="0" maxOccurs="999" ref="TS835W1_2110_Loop" />
      </xs:sequence>
    </xs:complexType>
  </xs:element>
  <xs:element name="CLP_ClaimPaymentInformation_TS835W1_2100">
    <xs:annotation>
      <xs:appinfo>
        <b:recordInfo tag_name="CLP_ClaimPaymentInformation_TS835W1_2100" structure="delimited" delimiter_type="inherit_field" field_order="prefix" count_ignore="no" child_delimiter="default" notes="Claim Payment Information" />
      </xs:appinfo>
    </xs:annotation>
    <xs:complexType>
      <xs:sequence>
        <xs:element name="CLP01__PatientControlNumber">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="AN" justification="left" sequence_number="01">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_AN">
              <xs:minLength value="1" />
              <xs:maxLength value="38" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element name="CLP02__ClaimStatusCode">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="ID" justification="left" codelist="1029" sequence_number="02">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_ID">
              <xs:enumeration value="1" />
              <xs:enumeration value="2" />
              <xs:enumeration value="3" />
              <xs:enumeration value="4" />
              <xs:enumeration value="5" />
              <xs:enumeration value="10" />
              <xs:enumeration value="13" />
              <xs:enumeration value="15" />
              <xs:enumeration value="16" />
              <xs:enumeration value="17" />
              <xs:enumeration value="19" />
              <xs:enumeration value="20" />
              <xs:enumeration value="21" />
              <xs:enumeration value="22" />
              <xs:enumeration value="23" />
              <xs:enumeration value="25" />
              <xs:enumeration value="27" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element name="CLP03__TotalClaimChargeAmount">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo custom_maxlength="18" edi_datatype="R" justification="right" sequence_number="03">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_R" />
          </xs:simpleType>
        </xs:element>
        <xs:element name="CLP04__ClaimPaymentAmount">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo custom_maxlength="18" edi_datatype="R" justification="right" sequence_number="04">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_R" />
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="CLP05__PatientResponsibilityAmount">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo custom_maxlength="18" edi_datatype="R" justification="right" sequence_number="05">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_R" />
          </xs:simpleType>
        </xs:element>
        <xs:element name="CLP06__ClaimFilingIndicatorCode">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="ID" justification="left" codelist="1032" sequence_number="06">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_ID">
              <xs:enumeration value="12" />
              <xs:enumeration value="13" />
              <xs:enumeration value="14" />
              <xs:enumeration value="15" />
              <xs:enumeration value="16" />
              <xs:enumeration value="AM" />
              <xs:enumeration value="CH" />
              <xs:enumeration value="DS" />
              <xs:enumeration value="HM" />
              <xs:enumeration value="LM" />
              <xs:enumeration value="MA" />
              <xs:enumeration value="MB" />
              <xs:enumeration value="MC" />
              <xs:enumeration value="OF" />
              <xs:enumeration value="TV" />
              <xs:enumeration value="VA" />
              <xs:enumeration value="WC" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="CLP07__PayerClaimControlNumber">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="AN" justification="left" sequence_number="07">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_AN">
              <xs:minLength value="1" />
              <xs:maxLength value="30" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="CLP08__FacilityTypeCode">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="AN" justification="left" sequence_number="08">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_AN">
              <xs:minLength value="1" />
              <xs:maxLength value="2" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="CLP09__ClaimFrequencyCode">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="ID" sequence_number="09">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_ID">
              <xs:minLength value="1" />
              <xs:maxLength value="1" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="CLP10">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="ID" justification="left" sequence_number="10">
              </b:fieldInfo>
              <wpc:Info NotUsed="true" />
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_ID">
              <xs:minLength value="1" />
              <xs:maxLength value="2" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="CLP11__DiagnosisRelatedGroupDRGCode">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="ID" justification="left" sequence_number="11">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_ID">
              <xs:minLength value="1" />
              <xs:maxLength value="4" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="CLP12__DiagnosisRelatedGroupDRGWeight">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo custom_maxlength="15" edi_datatype="R" justification="right" sequence_number="12">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_R" />
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="CLP13__DischargeFraction">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo custom_maxlength="10" edi_datatype="R" justification="right" sequence_number="13">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_R" />
          </xs:simpleType>
        </xs:element>
      </xs:sequence>
    </xs:complexType>
  </xs:element>
  <xs:element name="CAS_ClaimAdjustment_TS835W1_2100">
    <xs:annotation>
      <xs:appinfo>
        <b:recordInfo tag_name="CAS_ClaimAdjustment_TS835W1_2100" structure="delimited" delimiter_type="inherit_field" field_order="prefix" count_ignore="no" child_delimiter="default" notes="Claim Adjustment">
          <b:Rule subjects="X12ConditionDesignatorX_ListConditional" qualifier="CAS05__AdjustmentReasonCode">
            <b:Subject name="CAS06__AdjustmentAmount" />
            <b:Subject name="CAS07__AdjustmentQuantity" />
          </b:Rule>
          <b:Rule subjects="X12ConditionDesignatorX_Conditional" qualifier="CAS06__AdjustmentAmount">
            <b:Subject name="CAS05__AdjustmentReasonCode" />
          </b:Rule>
          <b:Rule subjects="X12ConditionDesignatorX_Conditional" qualifier="CAS07__AdjustmentQuantity">
            <b:Subject name="CAS05__AdjustmentReasonCode" />
          </b:Rule>
          <b:Rule subjects="X12ConditionDesignatorX_ListConditional" qualifier="CAS08__AdjustmentReasonCode">
            <b:Subject name="CAS09__AdjustmentAmount" />
            <b:Subject name="CAS10__AdjustmentQuantity" />
          </b:Rule>
          <b:Rule subjects="X12ConditionDesignatorX_Conditional" qualifier="CAS09__AdjustmentAmount">
            <b:Subject name="CAS08__AdjustmentReasonCode" />
          </b:Rule>
          <b:Rule subjects="X12ConditionDesignatorX_Conditional" qualifier="CAS10__AdjustmentQuantity">
            <b:Subject name="CAS08__AdjustmentReasonCode" />
          </b:Rule>
          <b:Rule subjects="X12ConditionDesignatorX_ListConditional" qualifier="CAS11__AdjustmentReasonCode">
            <b:Subject name="CAS12__AdjustmentAmount" />
            <b:Subject name="CAS13__AdjustmentQuantity" />
          </b:Rule>
          <b:Rule subjects="X12ConditionDesignatorX_Conditional" qualifier="CAS12__AdjustmentAmount">
            <b:Subject name="CAS11__AdjustmentReasonCode" />
          </b:Rule>
          <b:Rule subjects="X12ConditionDesignatorX_Conditional" qualifier="CAS13__AdjustmentQuantity">
            <b:Subject name="CAS11__AdjustmentReasonCode" />
          </b:Rule>
          <b:Rule subjects="X12ConditionDesignatorX_ListConditional" qualifier="CAS14__AdjustmentReasonCode">
            <b:Subject name="CAS15__AdjustmentAmount" />
            <b:Subject name="CAS16__AdjustmentQuantity" />
          </b:Rule>
          <b:Rule subjects="X12ConditionDesignatorX_Conditional" qualifier="CAS15__AdjustmentAmount">
            <b:Subject name="CAS14__AdjustmentReasonCode" />
          </b:Rule>
          <b:Rule subjects="X12ConditionDesignatorX_Conditional" qualifier="CAS16__AdjustmentQuantity">
            <b:Subject name="CAS14__AdjustmentReasonCode" />
          </b:Rule>
          <b:Rule subjects="X12ConditionDesignatorX_ListConditional" qualifier="CAS17__AdjustmentReasonCode">
            <b:Subject name="CAS18__AdjustmentAmount" />
            <b:Subject name="CAS19__AdjustmentQuantity" />
          </b:Rule>
          <b:Rule subjects="X12ConditionDesignatorX_Conditional" qualifier="CAS18__AdjustmentAmount">
            <b:Subject name="CAS17__AdjustmentReasonCode" />
          </b:Rule>
          <b:Rule subjects="X12ConditionDesignatorX_Conditional" qualifier="CAS19__AdjustmentQuantity">
            <b:Subject name="CAS17__AdjustmentReasonCode" />
          </b:Rule>
        </b:recordInfo>
      </xs:appinfo>
    </xs:annotation>
    <xs:complexType>
      <xs:sequence>
        <xs:element name="CAS01__ClaimAdjustmentGroupCode">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="ID" justification="left" codelist="1033" sequence_number="01">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_ID">
              <xs:enumeration value="CO" />
              <xs:enumeration value="CR" />
              <xs:enumeration value="OA" />
              <xs:enumeration value="PI" />
              <xs:enumeration value="PR" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element name="CAS02__AdjustmentReasonCode">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="ID" justification="left" sequence_number="02">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_ID">
              <xs:minLength value="1" />
              <xs:maxLength value="5" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element name="CAS03__AdjustmentAmount">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo custom_maxlength="18" edi_datatype="R" justification="right" sequence_number="03">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_R" />
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="CAS04__AdjustmentQuantity">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo custom_maxlength="15" edi_datatype="R" justification="right" sequence_number="04">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_R" />
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="CAS05__AdjustmentReasonCode">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="ID" justification="left" sequence_number="05">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_ID">
              <xs:minLength value="1" />
              <xs:maxLength value="5" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="CAS06__AdjustmentAmount">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo custom_maxlength="18" edi_datatype="R" justification="right" sequence_number="06">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_R" />
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="CAS07__AdjustmentQuantity">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo custom_maxlength="15" edi_datatype="R" justification="right" sequence_number="07">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_R" />
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="CAS08__AdjustmentReasonCode">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="ID" justification="left" sequence_number="08">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_ID">
              <xs:minLength value="1" />
              <xs:maxLength value="5" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="CAS09__AdjustmentAmount">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo custom_maxlength="18" edi_datatype="R" justification="right" sequence_number="09">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_R" />
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="CAS10__AdjustmentQuantity">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo custom_maxlength="15" edi_datatype="R" justification="right" sequence_number="10">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_R" />
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="CAS11__AdjustmentReasonCode">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="ID" justification="left" sequence_number="11">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_ID">
              <xs:minLength value="1" />
              <xs:maxLength value="5" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="CAS12__AdjustmentAmount">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo custom_maxlength="18" edi_datatype="R" justification="right" sequence_number="12">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_R" />
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="CAS13__AdjustmentQuantity">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo custom_maxlength="15" edi_datatype="R" justification="right" sequence_number="13">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_R" />
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="CAS14__AdjustmentReasonCode">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="ID" justification="left" sequence_number="14">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_ID">
              <xs:minLength value="1" />
              <xs:maxLength value="5" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="CAS15__AdjustmentAmount">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo custom_maxlength="18" edi_datatype="R" justification="right" sequence_number="15">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_R" />
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="CAS16__AdjustmentQuantity">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo custom_maxlength="15" edi_datatype="R" justification="right" sequence_number="16">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_R" />
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="CAS17__AdjustmentReasonCode">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="ID" justification="left" sequence_number="17">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_ID">
              <xs:minLength value="1" />
              <xs:maxLength value="5" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="CAS18__AdjustmentAmount">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo custom_maxlength="18" edi_datatype="R" justification="right" sequence_number="18">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_R" />
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="CAS19__AdjustmentQuantity">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo custom_maxlength="15" edi_datatype="R" justification="right" sequence_number="19">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_R" />
          </xs:simpleType>
        </xs:element>
      </xs:sequence>
    </xs:complexType>
  </xs:element>
  <xs:element name="NM1_PatientName_TS835W1_2100">
    <xs:annotation>
      <xs:appinfo>
        <b:recordInfo trigger_field="NM101__EntityIdentifierCode" trigger_value="QC" tag_name="NM1_PatientName_TS835W1_2100" structure="delimited" delimiter_type="inherit_field" field_order="prefix" count_ignore="no" child_delimiter="default" notes="Patient Name">
          <b:Rule subjects="X12ConditionDesignatorX_Paired">
            <b:Subject name="NM108__IdentificationCodeQualifier" />
            <b:Subject name="NM109__PatientIdentifier" />
          </b:Rule>
          <b:Rule subjects="X12ConditionDesignatorX_Conditional" qualifier="NM111">
            <b:Subject name="NM110" />
          </b:Rule>
        </b:recordInfo>
      </xs:appinfo>
    </xs:annotation>
    <xs:complexType>
      <xs:sequence>
        <xs:element name="NM101__EntityIdentifierCode">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="ID" justification="left" codelist="98" sequence_number="01">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_ID">
              <xs:enumeration value="QC" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element name="NM102__EntityTypeQualifier">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="ID" codelist="1065" sequence_number="02">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_ID">
              <xs:enumeration value="1" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element name="NM103__PatientLastName">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="AN" justification="left" sequence_number="03">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_AN">
              <xs:minLength value="1" />
              <xs:maxLength value="35" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element name="NM104__PatientFirstName">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="AN" justification="left" sequence_number="04">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_AN">
              <xs:minLength value="1" />
              <xs:maxLength value="25" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="NM105__PatientMiddleName">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="AN" justification="left" sequence_number="05">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_AN">
              <xs:minLength value="1" />
              <xs:maxLength value="25" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="NM106">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="AN" justification="left" sequence_number="06">
              </b:fieldInfo>
              <wpc:Info NotUsed="true" />
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_AN">
              <xs:minLength value="1" />
              <xs:maxLength value="10" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="NM107__PatientNameSuffix">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="AN" justification="left" sequence_number="07">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_AN">
              <xs:minLength value="1" />
              <xs:maxLength value="10" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="NM108__IdentificationCodeQualifier">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="ID" justification="left" codelist="66" sequence_number="08">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_ID">
              <xs:enumeration value="34" />
              <xs:enumeration value="HN" />
              <xs:enumeration value="MI" />
              <xs:enumeration value="MR" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="NM109__PatientIdentifier">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="AN" justification="left" sequence_number="09">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_AN">
              <xs:minLength value="2" />
              <xs:maxLength value="80" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="NM110">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="ID" sequence_number="10">
              </b:fieldInfo>
              <wpc:Info NotUsed="true" />
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_ID">
              <xs:minLength value="2" />
              <xs:maxLength value="2" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="NM111">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="ID" justification="left" sequence_number="11">
              </b:fieldInfo>
              <wpc:Info NotUsed="true" />
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_ID">
              <xs:minLength value="2" />
              <xs:maxLength value="3" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
      </xs:sequence>
    </xs:complexType>
  </xs:element>
  <xs:element name="NM1_InsuredName_TS835W1_2100">
    <xs:annotation>
      <xs:appinfo>
        <b:recordInfo trigger_field="NM101__EntityIdentifierCode" trigger_value="IL" tag_name="NM1_InsuredName_TS835W1_2100" structure="delimited" delimiter_type="inherit_field" field_order="prefix" count_ignore="no" child_delimiter="default" notes="Insured Name">
          <b:Rule subjects="X12ConditionDesignatorX_Paired">
            <b:Subject name="NM108__IdentificationCodeQualifier" />
            <b:Subject name="NM109__SubscriberIdentifier" />
          </b:Rule>
          <b:Rule subjects="X12ConditionDesignatorX_Conditional" qualifier="NM111">
            <b:Subject name="NM110" />
          </b:Rule>
        </b:recordInfo>
      </xs:appinfo>
    </xs:annotation>
    <xs:complexType>
      <xs:sequence>
        <xs:element name="NM101__EntityIdentifierCode">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="ID" justification="left" codelist="98" sequence_number="01">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_ID">
              <xs:enumeration value="IL" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element name="NM102__EntityTypeQualifier">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="ID" codelist="1065" sequence_number="02">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_ID">
              <xs:enumeration value="1" />
              <xs:enumeration value="2" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="NM103__SubscriberLastName">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="AN" justification="left" sequence_number="03">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_AN">
              <xs:minLength value="1" />
              <xs:maxLength value="35" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="NM104__SubscriberFirstName">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="AN" justification="left" sequence_number="04">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_AN">
              <xs:minLength value="1" />
              <xs:maxLength value="25" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="NM105__SubscriberMiddleName">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="AN" justification="left" sequence_number="05">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_AN">
              <xs:minLength value="1" />
              <xs:maxLength value="25" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="NM106">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="AN" justification="left" sequence_number="06">
              </b:fieldInfo>
              <wpc:Info NotUsed="true" />
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_AN">
              <xs:minLength value="1" />
              <xs:maxLength value="10" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="NM107__SubscriberNameSuffix">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="AN" justification="left" sequence_number="07">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_AN">
              <xs:minLength value="1" />
              <xs:maxLength value="10" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element name="NM108__IdentificationCodeQualifier">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="ID" justification="left" codelist="66" sequence_number="08">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_ID">
              <xs:enumeration value="34" />
              <xs:enumeration value="HN" />
              <xs:enumeration value="MI" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element name="NM109__SubscriberIdentifier">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="AN" justification="left" sequence_number="09">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_AN">
              <xs:minLength value="2" />
              <xs:maxLength value="80" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="NM110">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="ID" sequence_number="10">
              </b:fieldInfo>
              <wpc:Info NotUsed="true" />
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_ID">
              <xs:minLength value="2" />
              <xs:maxLength value="2" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="NM111">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="ID" justification="left" sequence_number="11">
              </b:fieldInfo>
              <wpc:Info NotUsed="true" />
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_ID">
              <xs:minLength value="2" />
              <xs:maxLength value="3" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
      </xs:sequence>
    </xs:complexType>
  </xs:element>
  <xs:element name="NM1_CorrectedPatientInsuredName_TS835W1_2100">
    <xs:annotation>
      <xs:appinfo>
        <b:recordInfo trigger_field="NM101__EntityIdentifierCode" trigger_value="74" tag_name="NM1_CorrectedPatientInsuredName_TS835W1_2100" structure="delimited" delimiter_type="inherit_field" field_order="prefix" count_ignore="no" child_delimiter="default" notes="Corrected Patient/Insured Name">
          <b:Rule subjects="X12ConditionDesignatorX_Paired">
            <b:Subject name="NM108__IdentificationCodeQualifier" />
            <b:Subject name="NM109__CorrectedInsuredIdentificationIndicator" />
          </b:Rule>
          <b:Rule subjects="X12ConditionDesignatorX_Conditional" qualifier="NM111">
            <b:Subject name="NM110" />
          </b:Rule>
        </b:recordInfo>
      </xs:appinfo>
    </xs:annotation>
    <xs:complexType>
      <xs:sequence>
        <xs:element name="NM101__EntityIdentifierCode">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="ID" justification="left" codelist="98" sequence_number="01">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_ID">
              <xs:enumeration value="74" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element name="NM102__EntityTypeQualifier">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="ID" codelist="1065" sequence_number="02">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_ID">
              <xs:enumeration value="1" />
              <xs:enumeration value="2" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="NM103__CorrectedPatientOrInsuredLastName">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="AN" justification="left" sequence_number="03">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_AN">
              <xs:minLength value="1" />
              <xs:maxLength value="35" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="NM104__CorrectedPatientOrInsuredFirstName">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="AN" justification="left" sequence_number="04">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_AN">
              <xs:minLength value="1" />
              <xs:maxLength value="25" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="NM105__CorrectedPatientOrInsuredMiddleName">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="AN" justification="left" sequence_number="05">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_AN">
              <xs:minLength value="1" />
              <xs:maxLength value="25" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="NM106">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="AN" justification="left" sequence_number="06">
              </b:fieldInfo>
              <wpc:Info NotUsed="true" />
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_AN">
              <xs:minLength value="1" />
              <xs:maxLength value="10" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="NM107__CorrectedPatientOrInsuredNameSuffix">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="AN" justification="left" sequence_number="07">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_AN">
              <xs:minLength value="1" />
              <xs:maxLength value="10" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="NM108__IdentificationCodeQualifier">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="ID" justification="left" codelist="66" sequence_number="08">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_ID">
              <xs:enumeration value="C" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="NM109__CorrectedInsuredIdentificationIndicator">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="AN" justification="left" sequence_number="09">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_AN">
              <xs:minLength value="2" />
              <xs:maxLength value="80" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="NM110">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="ID" sequence_number="10">
              </b:fieldInfo>
              <wpc:Info NotUsed="true" />
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_ID">
              <xs:minLength value="2" />
              <xs:maxLength value="2" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="NM111">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="ID" justification="left" sequence_number="11">
              </b:fieldInfo>
              <wpc:Info NotUsed="true" />
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_ID">
              <xs:minLength value="2" />
              <xs:maxLength value="3" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
      </xs:sequence>
    </xs:complexType>
  </xs:element>
  <xs:element name="NM1_ServiceProviderName_TS835W1_2100">
    <xs:annotation>
      <xs:appinfo>
        <b:recordInfo trigger_field="NM101__EntityIdentifierCode" trigger_value="82" tag_name="NM1_ServiceProviderName_TS835W1_2100" structure="delimited" delimiter_type="inherit_field" field_order="prefix" count_ignore="no" child_delimiter="default" notes="Service Provider Name">
          <b:Rule subjects="X12ConditionDesignatorX_Paired">
            <b:Subject name="NM108__IdentificationCodeQualifier" />
            <b:Subject name="NM109__RenderingProviderIdentifier" />
          </b:Rule>
          <b:Rule subjects="X12ConditionDesignatorX_Conditional" qualifier="NM111">
            <b:Subject name="NM110" />
          </b:Rule>
        </b:recordInfo>
      </xs:appinfo>
    </xs:annotation>
    <xs:complexType>
      <xs:sequence>
        <xs:element name="NM101__EntityIdentifierCode">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="ID" justification="left" codelist="98" sequence_number="01">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_ID">
              <xs:enumeration value="82" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element name="NM102__EntityTypeQualifier">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="ID" codelist="1065" sequence_number="02">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_ID">
              <xs:enumeration value="1" />
              <xs:enumeration value="2" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="NM103__RenderingProviderLastOrOrganizationName">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="AN" justification="left" sequence_number="03">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_AN">
              <xs:minLength value="1" />
              <xs:maxLength value="35" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="NM104__RenderingProviderFirstName">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="AN" justification="left" sequence_number="04">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_AN">
              <xs:minLength value="1" />
              <xs:maxLength value="25" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="NM105__RenderingProviderMiddleName">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="AN" justification="left" sequence_number="05">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_AN">
              <xs:minLength value="1" />
              <xs:maxLength value="25" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="NM106">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="AN" justification="left" sequence_number="06">
              </b:fieldInfo>
              <wpc:Info NotUsed="true" />
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_AN">
              <xs:minLength value="1" />
              <xs:maxLength value="10" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="NM107__RenderingProviderNameSuffix">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="AN" justification="left" sequence_number="07">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_AN">
              <xs:minLength value="1" />
              <xs:maxLength value="10" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element name="NM108__IdentificationCodeQualifier">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="ID" justification="left" codelist="66" sequence_number="08">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_ID">
              <xs:enumeration value="BD" />
              <xs:enumeration value="BS" />
              <xs:enumeration value="FI" />
              <xs:enumeration value="MC" />
              <xs:enumeration value="PC" />
              <xs:enumeration value="SL" />
              <xs:enumeration value="UP" />
              <xs:enumeration value="XX" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element name="NM109__RenderingProviderIdentifier">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="AN" justification="left" sequence_number="09">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_AN">
              <xs:minLength value="2" />
              <xs:maxLength value="80" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="NM110">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="ID" sequence_number="10">
              </b:fieldInfo>
              <wpc:Info NotUsed="true" />
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_ID">
              <xs:minLength value="2" />
              <xs:maxLength value="2" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="NM111">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="ID" justification="left" sequence_number="11">
              </b:fieldInfo>
              <wpc:Info NotUsed="true" />
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_ID">
              <xs:minLength value="2" />
              <xs:maxLength value="3" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
      </xs:sequence>
    </xs:complexType>
  </xs:element>
  <xs:element name="NM1_CrossoverCarrierName_TS835W1_2100">
    <xs:annotation>
      <xs:appinfo>
        <b:recordInfo trigger_field="NM101__EntityIdentifierCode" trigger_value="TT" tag_name="NM1_CrossoverCarrierName_TS835W1_2100" structure="delimited" delimiter_type="inherit_field" field_order="prefix" count_ignore="no" child_delimiter="default" notes="Crossover Carrier Name">
          <b:Rule subjects="X12ConditionDesignatorX_Paired">
            <b:Subject name="NM108__IdentificationCodeQualifier" />
            <b:Subject name="NM109__CoordinationOfBenefitsCarrierIdentifier" />
          </b:Rule>
          <b:Rule subjects="X12ConditionDesignatorX_Conditional" qualifier="NM111">
            <b:Subject name="NM110" />
          </b:Rule>
        </b:recordInfo>
      </xs:appinfo>
    </xs:annotation>
    <xs:complexType>
      <xs:sequence>
        <xs:element name="NM101__EntityIdentifierCode">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="ID" justification="left" codelist="98" sequence_number="01">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_ID">
              <xs:enumeration value="TT" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element name="NM102__EntityTypeQualifier">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="ID" codelist="1065" sequence_number="02">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_ID">
              <xs:enumeration value="2" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element name="NM103__CoordinationOfBenefitsCarrierName">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="AN" justification="left" sequence_number="03">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_AN">
              <xs:minLength value="1" />
              <xs:maxLength value="35" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="NM104">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="AN" justification="left" sequence_number="04">
              </b:fieldInfo>
              <wpc:Info NotUsed="true" />
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_AN">
              <xs:minLength value="1" />
              <xs:maxLength value="25" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="NM105">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="AN" justification="left" sequence_number="05">
              </b:fieldInfo>
              <wpc:Info NotUsed="true" />
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_AN">
              <xs:minLength value="1" />
              <xs:maxLength value="25" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="NM106">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="AN" justification="left" sequence_number="06">
              </b:fieldInfo>
              <wpc:Info NotUsed="true" />
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_AN">
              <xs:minLength value="1" />
              <xs:maxLength value="10" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="NM107">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="AN" justification="left" sequence_number="07">
              </b:fieldInfo>
              <wpc:Info NotUsed="true" />
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_AN">
              <xs:minLength value="1" />
              <xs:maxLength value="10" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element name="NM108__IdentificationCodeQualifier">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="ID" justification="left" codelist="66" sequence_number="08">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_ID">
              <xs:enumeration value="AD" />
              <xs:enumeration value="FI" />
              <xs:enumeration value="NI" />
              <xs:enumeration value="PI" />
              <xs:enumeration value="PP" />
              <xs:enumeration value="XV" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element name="NM109__CoordinationOfBenefitsCarrierIdentifier">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="AN" justification="left" sequence_number="09">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_AN">
              <xs:minLength value="2" />
              <xs:maxLength value="80" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="NM110">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="ID" sequence_number="10">
              </b:fieldInfo>
              <wpc:Info NotUsed="true" />
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_ID">
              <xs:minLength value="2" />
              <xs:maxLength value="2" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="NM111">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="ID" justification="left" sequence_number="11">
              </b:fieldInfo>
              <wpc:Info NotUsed="true" />
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_ID">
              <xs:minLength value="2" />
              <xs:maxLength value="3" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
      </xs:sequence>
    </xs:complexType>
  </xs:element>
  <xs:element name="NM1_CorrectedPriorityPayerName_TS835W1_2100">
    <xs:annotation>
      <xs:appinfo>
        <b:recordInfo trigger_field="NM101__EntityIdentifierCode" trigger_value="PR" tag_name="NM1_CorrectedPriorityPayerName_TS835W1_2100" structure="delimited" delimiter_type="inherit_field" field_order="prefix" count_ignore="no" child_delimiter="default" notes="Corrected Priority Payer Name">
          <b:Rule subjects="X12ConditionDesignatorX_Paired">
            <b:Subject name="NM108__IdentificationCodeQualifier" />
            <b:Subject name="NM109__CorrectedPriorityPayerIdentificationNumber" />
          </b:Rule>
          <b:Rule subjects="X12ConditionDesignatorX_Conditional" qualifier="NM111">
            <b:Subject name="NM110" />
          </b:Rule>
        </b:recordInfo>
      </xs:appinfo>
    </xs:annotation>
    <xs:complexType>
      <xs:sequence>
        <xs:element name="NM101__EntityIdentifierCode">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="ID" justification="left" codelist="98" sequence_number="01">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_ID">
              <xs:enumeration value="PR" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element name="NM102__EntityTypeQualifier">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="ID" codelist="1065" sequence_number="02">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_ID">
              <xs:enumeration value="2" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element name="NM103__CorrectedPriorityPayerName">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="AN" justification="left" sequence_number="03">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_AN">
              <xs:minLength value="1" />
              <xs:maxLength value="35" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="NM104">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="AN" justification="left" sequence_number="04">
              </b:fieldInfo>
              <wpc:Info NotUsed="true" />
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_AN">
              <xs:minLength value="1" />
              <xs:maxLength value="25" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="NM105">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="AN" justification="left" sequence_number="05">
              </b:fieldInfo>
              <wpc:Info NotUsed="true" />
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_AN">
              <xs:minLength value="1" />
              <xs:maxLength value="25" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="NM106">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="AN" justification="left" sequence_number="06">
              </b:fieldInfo>
              <wpc:Info NotUsed="true" />
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_AN">
              <xs:minLength value="1" />
              <xs:maxLength value="10" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="NM107">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="AN" justification="left" sequence_number="07">
              </b:fieldInfo>
              <wpc:Info NotUsed="true" />
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_AN">
              <xs:minLength value="1" />
              <xs:maxLength value="10" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element name="NM108__IdentificationCodeQualifier">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="ID" justification="left" codelist="66" sequence_number="08">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_ID">
              <xs:enumeration value="AD" />
              <xs:enumeration value="FI" />
              <xs:enumeration value="NI" />
              <xs:enumeration value="PI" />
              <xs:enumeration value="PP" />
              <xs:enumeration value="XV" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element name="NM109__CorrectedPriorityPayerIdentificationNumber">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="AN" justification="left" sequence_number="09">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_AN">
              <xs:minLength value="2" />
              <xs:maxLength value="80" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="NM110">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="ID" sequence_number="10">
              </b:fieldInfo>
              <wpc:Info NotUsed="true" />
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_ID">
              <xs:minLength value="2" />
              <xs:maxLength value="2" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="NM111">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="ID" justification="left" sequence_number="11">
              </b:fieldInfo>
              <wpc:Info NotUsed="true" />
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_ID">
              <xs:minLength value="2" />
              <xs:maxLength value="3" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
      </xs:sequence>
    </xs:complexType>
  </xs:element>
  <xs:element name="MIA_InpatientAdjudicationInformation_TS835W1_2100">
    <xs:annotation>
      <xs:appinfo>
        <b:recordInfo tag_name="MIA_InpatientAdjudicationInformation_TS835W1_2100" structure="delimited" delimiter_type="inherit_field" field_order="prefix" count_ignore="no" child_delimiter="default" notes="Inpatient Adjudication Information" />
      </xs:appinfo>
    </xs:annotation>
    <xs:complexType>
      <xs:sequence>
        <xs:element name="MIA01__CoveredDaysOrVisitsCount">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo custom_maxlength="15" edi_datatype="R" justification="right" sequence_number="01">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_R" />
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="MIA02__PPSOperatingOutlierAmount">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo custom_maxlength="15" edi_datatype="R" justification="right" sequence_number="02">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_R" />
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="MIA03__LifetimePsychiatricDaysCount">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo custom_maxlength="15" edi_datatype="R" justification="right" sequence_number="03">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_R" />
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="MIA04__ClaimDRGAmount">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo custom_maxlength="18" edi_datatype="R" justification="right" sequence_number="04">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_R" />
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="MIA05__RemarkCode">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="AN" justification="left" sequence_number="05">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_AN">
              <xs:minLength value="1" />
              <xs:maxLength value="30" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="MIA06__ClaimDisproportionateShareAmount">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo custom_maxlength="18" edi_datatype="R" justification="right" sequence_number="06">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_R" />
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="MIA07__ClaimMSPPassthroughAmount">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo custom_maxlength="18" edi_datatype="R" justification="right" sequence_number="07">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_R" />
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="MIA08__ClaimPPSCapitalAmount">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo custom_maxlength="18" edi_datatype="R" justification="right" sequence_number="08">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_R" />
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="MIA09__PPSCapitalFSPDRGAmount">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo custom_maxlength="18" edi_datatype="R" justification="right" sequence_number="09">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_R" />
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="MIA10__PPSCapitalHSPDRGAmount">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo custom_maxlength="18" edi_datatype="R" justification="right" sequence_number="10">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_R" />
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="MIA11__PPSCapitalDSHDRGAmount">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo custom_maxlength="18" edi_datatype="R" justification="right" sequence_number="11">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_R" />
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="MIA12__OldCapitalAmount">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo custom_maxlength="18" edi_datatype="R" justification="right" sequence_number="12">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_R" />
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="MIA13__PPSCapitalIMEAmount">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo custom_maxlength="18" edi_datatype="R" justification="right" sequence_number="13">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_R" />
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="MIA14__PPSOperatingHospitalSpecificDRGAmount">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo custom_maxlength="18" edi_datatype="R" justification="right" sequence_number="14">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_R" />
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="MIA15__CostReportDayCount">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo custom_maxlength="15" edi_datatype="R" justification="right" sequence_number="15">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_R" />
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="MIA16__PPSOperatingFederalSpecificDRGAmount">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo custom_maxlength="18" edi_datatype="R" justification="right" sequence_number="16">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_R" />
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="MIA17__ClaimPPSCapitalOutlierAmount">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo custom_maxlength="18" edi_datatype="R" justification="right" sequence_number="17">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_R" />
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="MIA18__ClaimIndirectTeachingAmount">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo custom_maxlength="18" edi_datatype="R" justification="right" sequence_number="18">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_R" />
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="MIA19__NonpayableProfessionalComponentAmount">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo custom_maxlength="18" edi_datatype="R" justification="right" sequence_number="19">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_R" />
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="MIA20__RemarkCode">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="AN" justification="left" sequence_number="20">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_AN">
              <xs:minLength value="1" />
              <xs:maxLength value="30" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="MIA21__RemarkCode">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="AN" justification="left" sequence_number="21">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_AN">
              <xs:minLength value="1" />
              <xs:maxLength value="30" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="MIA22__RemarkCode">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="AN" justification="left" sequence_number="22">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_AN">
              <xs:minLength value="1" />
              <xs:maxLength value="30" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="MIA23__RemarkCode">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="AN" justification="left" sequence_number="23">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_AN">
              <xs:minLength value="1" />
              <xs:maxLength value="30" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="MIA24__PPSCapitalExceptionAmount">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo custom_maxlength="18" edi_datatype="R" justification="right" sequence_number="24">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_R" />
          </xs:simpleType>
        </xs:element>
      </xs:sequence>
    </xs:complexType>
  </xs:element>
  <xs:element name="MOA_OutpatientAdjudicationInformation_TS835W1_2100">
    <xs:annotation>
      <xs:appinfo>
        <b:recordInfo tag_name="MOA_OutpatientAdjudicationInformation_TS835W1_2100" structure="delimited" delimiter_type="inherit_field" field_order="prefix" count_ignore="no" child_delimiter="default" notes="Outpatient Adjudication Information" />
      </xs:appinfo>
    </xs:annotation>
    <xs:complexType>
      <xs:sequence>
        <xs:element minOccurs="0" name="MOA01__ReimbursementRate">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo custom_maxlength="10" edi_datatype="R" justification="right" sequence_number="01">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_R" />
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="MOA02__ClaimHCPCSPayableAmount">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo custom_maxlength="18" edi_datatype="R" justification="right" sequence_number="02">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_R" />
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="MOA03__RemarkCode">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="AN" justification="left" sequence_number="03">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_AN">
              <xs:minLength value="1" />
              <xs:maxLength value="30" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="MOA04__RemarkCode">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="AN" justification="left" sequence_number="04">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_AN">
              <xs:minLength value="1" />
              <xs:maxLength value="30" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="MOA05__RemarkCode">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="AN" justification="left" sequence_number="05">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_AN">
              <xs:minLength value="1" />
              <xs:maxLength value="30" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="MOA06__RemarkCode">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="AN" justification="left" sequence_number="06">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_AN">
              <xs:minLength value="1" />
              <xs:maxLength value="30" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="MOA07__RemarkCode">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="AN" justification="left" sequence_number="07">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_AN">
              <xs:minLength value="1" />
              <xs:maxLength value="30" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="MOA08__ClaimESRDPaymentAmount">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo custom_maxlength="18" edi_datatype="R" justification="right" sequence_number="08">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_R" />
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="MOA09__NonpayableProfessionalComponentAmount">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo custom_maxlength="18" edi_datatype="R" justification="right" sequence_number="09">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_R" />
          </xs:simpleType>
        </xs:element>
      </xs:sequence>
    </xs:complexType>
  </xs:element>
  <xs:element name="REF_OtherClaimRelatedIdentification_TS835W1_2100">
    <xs:annotation>
      <xs:appinfo>
        <b:recordInfo trigger_field="REF01__ReferenceIdentificationQualifier" trigger_value="1L 1W 9A 9C A6 BB CE EA F8 G1 G3 IG SY" tag_name="REF_OtherClaimRelatedIdentification_TS835W1_2100" structure="delimited" delimiter_type="inherit_field" field_order="prefix" count_ignore="no" child_delimiter="default" notes="Other Claim Related Identification">
          <b:Rule subjects="X12ConditionDesignatorX_Required">
            <b:Subject name="REF02__OtherClaimRelatedIdentifier" />
            <b:Subject name="REF03" />
          </b:Rule>
        </b:recordInfo>
      </xs:appinfo>
    </xs:annotation>
    <xs:complexType>
      <xs:sequence>
        <xs:element name="REF01__ReferenceIdentificationQualifier">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="ID" justification="left" codelist="128" sequence_number="01">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_ID">
              <xs:enumeration value="1L" />
              <xs:enumeration value="1W" />
              <xs:enumeration value="9A" />
              <xs:enumeration value="9C" />
              <xs:enumeration value="A6" />
              <xs:enumeration value="BB" />
              <xs:enumeration value="CE" />
              <xs:enumeration value="EA" />
              <xs:enumeration value="F8" />
              <xs:enumeration value="G1" />
              <xs:enumeration value="G3" />
              <xs:enumeration value="IG" />
              <xs:enumeration value="SY" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element name="REF02__OtherClaimRelatedIdentifier">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="AN" justification="left" sequence_number="02">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_AN">
              <xs:minLength value="1" />
              <xs:maxLength value="30" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="REF03">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="AN" justification="left" sequence_number="03">
              </b:fieldInfo>
              <wpc:Info NotUsed="true" />
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_AN">
              <xs:minLength value="1" />
              <xs:maxLength value="80" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="REF04_C040U786">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="AN" sequence_number="04">
              </b:fieldInfo>
              <wpc:Info NotUsed="true" />
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_AN">
              <xs:minLength value="1" />
              <xs:maxLength value="1" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
      </xs:sequence>
    </xs:complexType>
  </xs:element>
  <xs:element name="REF_RenderingProviderIdentification_TS835W1_2100">
    <xs:annotation>
      <xs:appinfo>
        <b:recordInfo trigger_field="REF01__ReferenceIdentificationQualifier" trigger_value="1A 1B 1C 1D 1G 1H D3 G2" tag_name="REF_RenderingProviderIdentification_TS835W1_2100" structure="delimited" delimiter_type="inherit_field" field_order="prefix" count_ignore="no" child_delimiter="default" notes="Rendering Provider Identification">
          <b:Rule subjects="X12ConditionDesignatorX_Required">
            <b:Subject name="REF02__RenderingProviderSecondaryIdentifier" />
            <b:Subject name="REF03" />
          </b:Rule>
        </b:recordInfo>
      </xs:appinfo>
    </xs:annotation>
    <xs:complexType>
      <xs:sequence>
        <xs:element name="REF01__ReferenceIdentificationQualifier">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="ID" justification="left" codelist="128" sequence_number="01">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_ID">
              <xs:enumeration value="1A" />
              <xs:enumeration value="1B" />
              <xs:enumeration value="1C" />
              <xs:enumeration value="1D" />
              <xs:enumeration value="1G" />
              <xs:enumeration value="1H" />
              <xs:enumeration value="D3" />
              <xs:enumeration value="G2" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element name="REF02__RenderingProviderSecondaryIdentifier">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="AN" justification="left" sequence_number="02">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_AN">
              <xs:minLength value="1" />
              <xs:maxLength value="30" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="REF03">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="AN" justification="left" sequence_number="03">
              </b:fieldInfo>
              <wpc:Info NotUsed="true" />
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_AN">
              <xs:minLength value="1" />
              <xs:maxLength value="80" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="REF04_C040U787">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="AN" sequence_number="04">
              </b:fieldInfo>
              <wpc:Info NotUsed="true" />
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_AN">
              <xs:minLength value="1" />
              <xs:maxLength value="1" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
      </xs:sequence>
    </xs:complexType>
  </xs:element>
  <xs:element name="DTM_ClaimDate_TS835W1_2100">
    <xs:annotation>
      <xs:appinfo>
        <b:recordInfo tag_name="DTM_ClaimDate_TS835W1_2100" structure="delimited" delimiter_type="inherit_field" field_order="prefix" count_ignore="no" child_delimiter="default" notes="Claim Date">
          <b:Rule subjects="X12ConditionDesignatorX_Required">
            <b:Subject name="DTM02__ClaimDate" />
            <b:Subject name="DTM03" />
            <b:Subject name="DTM05" />
          </b:Rule>
          <b:Rule subjects="X12ConditionDesignatorX_Conditional" qualifier="DTM04">
            <b:Subject name="DTM03" />
          </b:Rule>
          <b:Rule subjects="X12ConditionDesignatorX_Paired">
            <b:Subject name="DTM05" />
            <b:Subject name="DTM06" />
          </b:Rule>
        </b:recordInfo>
      </xs:appinfo>
    </xs:annotation>
    <xs:complexType>
      <xs:sequence>
        <xs:element name="DTM01__DateTimeQualifier">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="ID" codelist="374" sequence_number="01">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_ID">
              <xs:enumeration value="036" />
              <xs:enumeration value="050" />
              <xs:enumeration value="232" />
              <xs:enumeration value="233" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element name="DTM02__ClaimDate">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="DT" format="YYYYMMDD" sequence_number="02">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_DT">
              <xs:minLength value="8" />
              <xs:maxLength value="8" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="DTM03">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="TM" format="HHMMSSDD" sequence_number="03">
              </b:fieldInfo>
              <wpc:Info NotUsed="true" />
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_TM">
              <xs:minLength value="4" />
              <xs:maxLength value="8" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="DTM04">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="ID" sequence_number="04">
              </b:fieldInfo>
              <wpc:Info NotUsed="true" />
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_ID">
              <xs:minLength value="2" />
              <xs:maxLength value="2" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="DTM05">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="ID" justification="left" sequence_number="05">
              </b:fieldInfo>
              <wpc:Info NotUsed="true" />
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_ID">
              <xs:minLength value="2" />
              <xs:maxLength value="3" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="DTM06">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="AN" justification="left" sequence_number="06">
              </b:fieldInfo>
              <wpc:Info NotUsed="true" />
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_AN">
              <xs:minLength value="1" />
              <xs:maxLength value="35" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
      </xs:sequence>
    </xs:complexType>
  </xs:element>
  <xs:element name="PER_ClaimContactInformation_TS835W1_2100">
    <xs:annotation>
      <xs:appinfo>
        <b:recordInfo tag_name="PER_ClaimContactInformation_TS835W1_2100" structure="delimited" delimiter_type="inherit_field" field_order="prefix" count_ignore="no" child_delimiter="default" notes="Claim Contact Information">
          <b:Rule subjects="X12ConditionDesignatorX_Paired">
            <b:Subject name="PER03__CommunicationNumberQualifier" />
            <b:Subject name="PER04__ClaimContactCommunicationsNumber" />
          </b:Rule>
          <b:Rule subjects="X12ConditionDesignatorX_Paired">
            <b:Subject name="PER05__CommunicationNumberQualifier" />
            <b:Subject name="PER06__ClaimContactCommunicationsNumber" />
          </b:Rule>
          <b:Rule subjects="X12ConditionDesignatorX_Paired">
            <b:Subject name="PER07__CommunicationNumberQualifier" />
            <b:Subject name="PER08__CommunicationNumberExtension" />
          </b:Rule>
        </b:recordInfo>
      </xs:appinfo>
    </xs:annotation>
    <xs:complexType>
      <xs:sequence>
        <xs:element name="PER01__ContactFunctionCode">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="ID" codelist="366" sequence_number="01">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_ID">
              <xs:enumeration value="CX" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="PER02__ClaimContactName">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="AN" justification="left" sequence_number="02">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_AN">
              <xs:minLength value="1" />
              <xs:maxLength value="60" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="PER03__CommunicationNumberQualifier">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="ID" codelist="365" sequence_number="03">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_ID">
              <xs:enumeration value="EM" />
              <xs:enumeration value="FX" />
              <xs:enumeration value="TE" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="PER04__ClaimContactCommunicationsNumber">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="AN" justification="left" sequence_number="04">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_AN">
              <xs:minLength value="1" />
              <xs:maxLength value="80" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="PER05__CommunicationNumberQualifier">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="ID" codelist="365" sequence_number="05">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_ID">
              <xs:enumeration value="EM" />
              <xs:enumeration value="EX" />
              <xs:enumeration value="FX" />
              <xs:enumeration value="TE" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="PER06__ClaimContactCommunicationsNumber">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="AN" justification="left" sequence_number="06">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_AN">
              <xs:minLength value="1" />
              <xs:maxLength value="80" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="PER07__CommunicationNumberQualifier">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="ID" codelist="365" sequence_number="07">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_ID">
              <xs:enumeration value="EX" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="PER08__CommunicationNumberExtension">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="AN" justification="left" sequence_number="08">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_AN">
              <xs:minLength value="1" />
              <xs:maxLength value="80" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="PER09">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="AN" justification="left" sequence_number="09">
              </b:fieldInfo>
              <wpc:Info NotUsed="true" />
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_AN">
              <xs:minLength value="1" />
              <xs:maxLength value="20" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
      </xs:sequence>
    </xs:complexType>
  </xs:element>
  <xs:element name="AMT_ClaimSupplementalInformation_TS835W1_2100">
    <xs:annotation>
      <xs:appinfo>
        <b:recordInfo tag_name="AMT_ClaimSupplementalInformation_TS835W1_2100" structure="delimited" delimiter_type="inherit_field" field_order="prefix" count_ignore="no" child_delimiter="default" notes="Claim Supplemental Information" />
      </xs:appinfo>
    </xs:annotation>
    <xs:complexType>
      <xs:sequence>
        <xs:element name="AMT01__AmountQualifierCode">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="ID" justification="left" codelist="522" sequence_number="01">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_ID">
              <xs:enumeration value="AU" />
              <xs:enumeration value="D8" />
              <xs:enumeration value="DY" />
              <xs:enumeration value="F5" />
              <xs:enumeration value="I" />
              <xs:enumeration value="NL" />
              <xs:enumeration value="T" />
              <xs:enumeration value="ZK" />
              <xs:enumeration value="ZL" />
              <xs:enumeration value="ZM" />
              <xs:enumeration value="ZN" />
              <xs:enumeration value="ZO" />
              <xs:enumeration value="ZZ" />
              <xs:enumeration value="T2" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element name="AMT02__ClaimSupplementalInformationAmount">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo custom_maxlength="18" edi_datatype="R" justification="right" sequence_number="02">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_R" />
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="AMT03">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="ID" sequence_number="03">
              </b:fieldInfo>
              <wpc:Info NotUsed="true" />
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_ID">
              <xs:minLength value="1" />
              <xs:maxLength value="1" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
      </xs:sequence>
    </xs:complexType>
  </xs:element>
  <xs:element name="QTY_ClaimSupplementalInformationQuantity_TS835W1_2100">
    <xs:annotation>
      <xs:appinfo>
        <b:recordInfo tag_name="QTY_ClaimSupplementalInformationQuantity_TS835W1_2100" structure="delimited" delimiter_type="inherit_field" field_order="prefix" count_ignore="no" child_delimiter="default" notes="Claim Supplemental Information Quantity">
          <b:Rule subjects="X12ConditionDesignatorX_Required">
            <b:Subject name="QTY02__ClaimSupplementalInformationQuantity" />
            <b:Subject name="QTY04" />
          </b:Rule>
          <b:Rule subjects="X12ConditionDesignatorX_Exclusion">
            <b:Subject name="QTY02__ClaimSupplementalInformationQuantity" />
            <b:Subject name="QTY04" />
          </b:Rule>
        </b:recordInfo>
      </xs:appinfo>
    </xs:annotation>
    <xs:complexType>
      <xs:sequence>
        <xs:element name="QTY01__QuantityQualifier">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="ID" codelist="673" sequence_number="01">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_ID">
              <xs:enumeration value="CA" />
              <xs:enumeration value="CD" />
              <xs:enumeration value="LA" />
              <xs:enumeration value="LE" />
              <xs:enumeration value="NA" />
              <xs:enumeration value="NE" />
              <xs:enumeration value="NR" />
              <xs:enumeration value="OU" />
              <xs:enumeration value="PS" />
              <xs:enumeration value="VS" />
              <xs:enumeration value="ZK" />
              <xs:enumeration value="ZL" />
              <xs:enumeration value="ZM" />
              <xs:enumeration value="ZN" />
              <xs:enumeration value="ZO" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element name="QTY02__ClaimSupplementalInformationQuantity">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo custom_maxlength="15" edi_datatype="R" justification="right" sequence_number="02">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_R" />
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="QTY03_C001U788">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="AN" sequence_number="03">
              </b:fieldInfo>
              <wpc:Info NotUsed="true" />
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_AN">
              <xs:minLength value="1" />
              <xs:maxLength value="1" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="QTY04">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="AN" justification="left" sequence_number="04">
              </b:fieldInfo>
              <wpc:Info NotUsed="true" />
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_AN">
              <xs:minLength value="1" />
              <xs:maxLength value="30" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
      </xs:sequence>
    </xs:complexType>
  </xs:element>
  <xs:element name="TS835W1_2110_Loop">
    <xs:annotation>
      <xs:appinfo>
        <b:recordInfo structure="delimited" delimiter_type="inherit_record" field_order="infix" count_ignore="yes" child_delimiter="default" notes="Service Payment Information" />
      </xs:appinfo>
    </xs:annotation>
    <xs:complexType>
      <xs:sequence>
        <xs:element minOccurs="1" maxOccurs="1" ref="SVC_ServicePaymentInformation_TS835W1_2110" />
        <xs:element minOccurs="0" maxOccurs="3" ref="DTM_ServiceDate_TS835W1_2110" />
        <xs:element minOccurs="0" maxOccurs="99" ref="CAS_ServiceAdjustment_TS835W1_2110" />
        <xs:element minOccurs="0" maxOccurs="7" ref="REF_ServiceIdentification_TS835W1_2110" />
        <xs:element minOccurs="0" maxOccurs="10" ref="REF_RenderingProviderInformation_TS835W1_2110" />
        <xs:element minOccurs="0" maxOccurs="12" ref="AMT_ServiceSupplementalAmount_TS835W1_2110" />
        <xs:element minOccurs="0" maxOccurs="6" ref="QTY_ServiceSupplementalQuantity_TS835W1_2110" />
        <xs:element minOccurs="0" maxOccurs="99" ref="LQ_HealthCareRemarkCodes_TS835W1_2110" />
      </xs:sequence>
    </xs:complexType>
  </xs:element>
  <xs:element name="SVC_ServicePaymentInformation_TS835W1_2110">
    <xs:annotation>
      <xs:appinfo>
        <b:recordInfo tag_name="SVC_ServicePaymentInformation_TS835W1_2110" structure="delimited" child_delimiter="default" delimiter_type="inherit_field" field_order="prefix" count_ignore="no" notes="Service Payment Information" />
      </xs:appinfo>
    </xs:annotation>
    <xs:complexType>
      <xs:sequence>
        <xs:element minOccurs="1" maxOccurs="1" ref="SVC01_C003U789_TS835W1_2110" />
        <xs:element name="SVC02__LineItemChargeAmount">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo custom_maxlength="18" edi_datatype="R" justification="right" sequence_number="02">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_R" />
          </xs:simpleType>
        </xs:element>
        <xs:element name="SVC03__LineItemProviderPaymentAmount">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo custom_maxlength="18" edi_datatype="R" justification="right" sequence_number="03">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_R" />
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="SVC04__NationalUniformBillingCommitteeRevenueCode">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="AN" justification="left" sequence_number="04">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_AN">
              <xs:minLength value="1" />
              <xs:maxLength value="48" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="SVC05__UnitsOfServicePaidCount">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo custom_maxlength="15" edi_datatype="R" justification="right" sequence_number="05">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_R" />
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" maxOccurs="1" ref="SVC06_C003U797_TS835W1_2110" />
        <xs:element minOccurs="0" name="SVC07__OriginalUnitsOfServiceCount">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo custom_maxlength="15" edi_datatype="R" justification="right" sequence_number="07">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_R" />
          </xs:simpleType>
        </xs:element>
      </xs:sequence>
    </xs:complexType>
  </xs:element>
  <xs:element name="SVC01_C003U789_TS835W1_2110">
    <xs:annotation>
      <xs:appinfo>
        <b:recordInfo structure="delimited" child_delimiter="default" delimiter_type="inherit_subfield" field_order="infix" count_ignore="yes" sequence_number="01" notes="Composite Medical Procedure Identifier" />
      </xs:appinfo>
    </xs:annotation>
    <xs:complexType>
      <xs:sequence>
        <xs:element name="SVC01_C00301U790_ProductOrServiceIDQualifier">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="ID" codelist="235" sequence_number="1">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_ID">
              <xs:enumeration value="AD" />
              <xs:enumeration value="ER" />
              <xs:enumeration value="HC" />
              <xs:enumeration value="ID" />
              <xs:enumeration value="IV" />
              <xs:enumeration value="N4" />
              <xs:enumeration value="NU" />
              <xs:enumeration value="RB" />
              <xs:enumeration value="ZZ" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element name="SVC01_C00302U791_ProcedureCode">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="AN" justification="left" sequence_number="2">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_AN">
              <xs:minLength value="1" />
              <xs:maxLength value="48" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="SVC01_C00303U792_ProcedureModifier">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="AN" sequence_number="3">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_AN">
              <xs:minLength value="2" />
              <xs:maxLength value="2" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="SVC01_C00304U793_ProcedureModifier">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="AN" sequence_number="4">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_AN">
              <xs:minLength value="2" />
              <xs:maxLength value="2" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="SVC01_C00305U794_ProcedureModifier">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="AN" sequence_number="5">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_AN">
              <xs:minLength value="2" />
              <xs:maxLength value="2" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="SVC01_C00306U795_ProcedureModifier">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="AN" sequence_number="6">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_AN">
              <xs:minLength value="2" />
              <xs:maxLength value="2" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="SVC01_C00307U796_ProcedureCodeDescription">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="AN" justification="left" sequence_number="7">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_AN">
              <xs:minLength value="1" />
              <xs:maxLength value="80" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
      </xs:sequence>
    </xs:complexType>
  </xs:element>
  <xs:element name="SVC06_C003U797_TS835W1_2110">
    <xs:annotation>
      <xs:appinfo>
        <b:recordInfo structure="delimited" child_delimiter="default" delimiter_type="inherit_subfield" field_order="infix" count_ignore="yes" sequence_number="06" notes="Composite Medical Procedure Identifier" />
      </xs:appinfo>
    </xs:annotation>
    <xs:complexType>
      <xs:sequence>
        <xs:element name="SVC06_C00301U798_ProductOrServiceIDQualifier">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="ID" codelist="235" sequence_number="1">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_ID">
              <xs:enumeration value="AD" />
              <xs:enumeration value="ER" />
              <xs:enumeration value="HC" />
              <xs:enumeration value="ID" />
              <xs:enumeration value="IV" />
              <xs:enumeration value="N4" />
              <xs:enumeration value="NU" />
              <xs:enumeration value="RB" />
              <xs:enumeration value="ZZ" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element name="SVC06_C00302U799_ProcedureCode">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="AN" justification="left" sequence_number="2">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_AN">
              <xs:minLength value="1" />
              <xs:maxLength value="48" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="SVC06_C00303U800_ProcedureModifier">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="AN" sequence_number="3">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_AN">
              <xs:minLength value="2" />
              <xs:maxLength value="2" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="SVC06_C00304U801_ProcedureModifier">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="AN" sequence_number="4">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_AN">
              <xs:minLength value="2" />
              <xs:maxLength value="2" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="SVC06_C00305U802_ProcedureModifier">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="AN" sequence_number="5">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_AN">
              <xs:minLength value="2" />
              <xs:maxLength value="2" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="SVC06_C00306U803_ProcedureModifier">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="AN" sequence_number="6">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_AN">
              <xs:minLength value="2" />
              <xs:maxLength value="2" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="SVC06_C00307U804_ProcedureCodeDescription">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="AN" justification="left" sequence_number="7">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_AN">
              <xs:minLength value="1" />
              <xs:maxLength value="80" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
      </xs:sequence>
    </xs:complexType>
  </xs:element>
  <xs:element name="DTM_ServiceDate_TS835W1_2110">
    <xs:annotation>
      <xs:appinfo>
        <b:recordInfo tag_name="DTM_ServiceDate_TS835W1_2110" structure="delimited" delimiter_type="inherit_field" field_order="prefix" count_ignore="no" child_delimiter="default" notes="Service Date">
          <b:Rule subjects="X12ConditionDesignatorX_Required">
            <b:Subject name="DTM02__ServiceDate" />
            <b:Subject name="DTM03" />
            <b:Subject name="DTM05" />
          </b:Rule>
          <b:Rule subjects="X12ConditionDesignatorX_Conditional" qualifier="DTM04">
            <b:Subject name="DTM03" />
          </b:Rule>
          <b:Rule subjects="X12ConditionDesignatorX_Paired">
            <b:Subject name="DTM05" />
            <b:Subject name="DTM06" />
          </b:Rule>
        </b:recordInfo>
      </xs:appinfo>
    </xs:annotation>
    <xs:complexType>
      <xs:sequence>
        <xs:element name="DTM01__DateTimeQualifier">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="ID" codelist="374" sequence_number="01">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_ID">
              <xs:enumeration value="150" />
              <xs:enumeration value="151" />
              <xs:enumeration value="472" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element name="DTM02__ServiceDate">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="DT" format="YYYYMMDD" sequence_number="02">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_DT">
              <xs:minLength value="8" />
              <xs:maxLength value="8" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="DTM03">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="TM" format="HHMMSSDD" sequence_number="03">
              </b:fieldInfo>
              <wpc:Info NotUsed="true" />
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_TM">
              <xs:minLength value="4" />
              <xs:maxLength value="8" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="DTM04">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="ID" sequence_number="04">
              </b:fieldInfo>
              <wpc:Info NotUsed="true" />
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_ID">
              <xs:minLength value="2" />
              <xs:maxLength value="2" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="DTM05">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="ID" justification="left" sequence_number="05">
              </b:fieldInfo>
              <wpc:Info NotUsed="true" />
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_ID">
              <xs:minLength value="2" />
              <xs:maxLength value="3" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="DTM06">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="AN" justification="left" sequence_number="06">
              </b:fieldInfo>
              <wpc:Info NotUsed="true" />
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_AN">
              <xs:minLength value="1" />
              <xs:maxLength value="35" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
      </xs:sequence>
    </xs:complexType>
  </xs:element>
  <xs:element name="CAS_ServiceAdjustment_TS835W1_2110">
    <xs:annotation>
      <xs:appinfo>
        <b:recordInfo tag_name="CAS_ServiceAdjustment_TS835W1_2110" structure="delimited" delimiter_type="inherit_field" field_order="prefix" count_ignore="no" child_delimiter="default" notes="Service Adjustment">
          <b:Rule subjects="X12ConditionDesignatorX_ListConditional" qualifier="CAS05__AdjustmentReasonCode">
            <b:Subject name="CAS06__AdjustmentAmount" />
            <b:Subject name="CAS07__AdjustmentQuantity" />
          </b:Rule>
          <b:Rule subjects="X12ConditionDesignatorX_Conditional" qualifier="CAS06__AdjustmentAmount">
            <b:Subject name="CAS05__AdjustmentReasonCode" />
          </b:Rule>
          <b:Rule subjects="X12ConditionDesignatorX_Conditional" qualifier="CAS07__AdjustmentQuantity">
            <b:Subject name="CAS05__AdjustmentReasonCode" />
          </b:Rule>
          <b:Rule subjects="X12ConditionDesignatorX_ListConditional" qualifier="CAS08__AdjustmentReasonCode">
            <b:Subject name="CAS09__AdjustmentAmount" />
            <b:Subject name="CAS10__AdjustmentQuantity" />
          </b:Rule>
          <b:Rule subjects="X12ConditionDesignatorX_Conditional" qualifier="CAS09__AdjustmentAmount">
            <b:Subject name="CAS08__AdjustmentReasonCode" />
          </b:Rule>
          <b:Rule subjects="X12ConditionDesignatorX_Conditional" qualifier="CAS10__AdjustmentQuantity">
            <b:Subject name="CAS08__AdjustmentReasonCode" />
          </b:Rule>
          <b:Rule subjects="X12ConditionDesignatorX_ListConditional" qualifier="CAS11__AdjustmentReasonCode">
            <b:Subject name="CAS12__AdjustmentAmount" />
            <b:Subject name="CAS13__AdjustmentQuantity" />
          </b:Rule>
          <b:Rule subjects="X12ConditionDesignatorX_Conditional" qualifier="CAS12__AdjustmentAmount">
            <b:Subject name="CAS11__AdjustmentReasonCode" />
          </b:Rule>
          <b:Rule subjects="X12ConditionDesignatorX_Conditional" qualifier="CAS13__AdjustmentQuantity">
            <b:Subject name="CAS11__AdjustmentReasonCode" />
          </b:Rule>
          <b:Rule subjects="X12ConditionDesignatorX_ListConditional" qualifier="CAS14__AdjustmentReasonCode">
            <b:Subject name="CAS15__AdjustmentAmount" />
            <b:Subject name="CAS16__AdjustmentQuantity" />
          </b:Rule>
          <b:Rule subjects="X12ConditionDesignatorX_Conditional" qualifier="CAS15__AdjustmentAmount">
            <b:Subject name="CAS14__AdjustmentReasonCode" />
          </b:Rule>
          <b:Rule subjects="X12ConditionDesignatorX_Conditional" qualifier="CAS16__AdjustmentQuantity">
            <b:Subject name="CAS14__AdjustmentReasonCode" />
          </b:Rule>
          <b:Rule subjects="X12ConditionDesignatorX_ListConditional" qualifier="CAS17__AdjustmentReasonCode">
            <b:Subject name="CAS18__AdjustmentAmount" />
            <b:Subject name="CAS19__AdjustmentQuantity" />
          </b:Rule>
          <b:Rule subjects="X12ConditionDesignatorX_Conditional" qualifier="CAS18__AdjustmentAmount">
            <b:Subject name="CAS17__AdjustmentReasonCode" />
          </b:Rule>
          <b:Rule subjects="X12ConditionDesignatorX_Conditional" qualifier="CAS19__AdjustmentQuantity">
            <b:Subject name="CAS17__AdjustmentReasonCode" />
          </b:Rule>
        </b:recordInfo>
      </xs:appinfo>
    </xs:annotation>
    <xs:complexType>
      <xs:sequence>
        <xs:element name="CAS01__ClaimAdjustmentGroupCode">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="ID" justification="left" codelist="1033" sequence_number="01">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_ID">
              <xs:enumeration value="CO" />
              <xs:enumeration value="CR" />
              <xs:enumeration value="OA" />
              <xs:enumeration value="PI" />
              <xs:enumeration value="PR" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element name="CAS02__AdjustmentReasonCode">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="ID" justification="left" sequence_number="02">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_ID">
              <xs:minLength value="1" />
              <xs:maxLength value="5" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element name="CAS03__AdjustmentAmount">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo custom_maxlength="18" edi_datatype="R" justification="right" sequence_number="03">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_R" />
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="CAS04__AdjustmentQuantity">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo custom_maxlength="15" edi_datatype="R" justification="right" sequence_number="04">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_R" />
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="CAS05__AdjustmentReasonCode">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="ID" justification="left" sequence_number="05">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_ID">
              <xs:minLength value="1" />
              <xs:maxLength value="5" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="CAS06__AdjustmentAmount">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo custom_maxlength="18" edi_datatype="R" justification="right" sequence_number="06">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_R" />
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="CAS07__AdjustmentQuantity">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo custom_maxlength="15" edi_datatype="R" justification="right" sequence_number="07">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_R" />
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="CAS08__AdjustmentReasonCode">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="ID" justification="left" sequence_number="08">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_ID">
              <xs:minLength value="1" />
              <xs:maxLength value="5" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="CAS09__AdjustmentAmount">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo custom_maxlength="18" edi_datatype="R" justification="right" sequence_number="09">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_R" />
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="CAS10__AdjustmentQuantity">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo custom_maxlength="15" edi_datatype="R" justification="right" sequence_number="10">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_R" />
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="CAS11__AdjustmentReasonCode">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="ID" justification="left" sequence_number="11">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_ID">
              <xs:minLength value="1" />
              <xs:maxLength value="5" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="CAS12__AdjustmentAmount">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo custom_maxlength="18" edi_datatype="R" justification="right" sequence_number="12">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_R" />
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="CAS13__AdjustmentQuantity">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo custom_maxlength="15" edi_datatype="R" justification="right" sequence_number="13">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_R" />
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="CAS14__AdjustmentReasonCode">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="ID" justification="left" sequence_number="14">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_ID">
              <xs:minLength value="1" />
              <xs:maxLength value="5" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="CAS15__AdjustmentAmount">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo custom_maxlength="18" edi_datatype="R" justification="right" sequence_number="15">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_R" />
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="CAS16__AdjustmentQuantity">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo custom_maxlength="15" edi_datatype="R" justification="right" sequence_number="16">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_R" />
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="CAS17__AdjustmentReasonCode">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="ID" justification="left" sequence_number="17">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_ID">
              <xs:minLength value="1" />
              <xs:maxLength value="5" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="CAS18__AdjustmentAmount">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo custom_maxlength="18" edi_datatype="R" justification="right" sequence_number="18">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_R" />
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="CAS19__AdjustmentQuantity">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo custom_maxlength="15" edi_datatype="R" justification="right" sequence_number="19">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_R" />
          </xs:simpleType>
        </xs:element>
      </xs:sequence>
    </xs:complexType>
  </xs:element>
  <xs:element name="REF_ServiceIdentification_TS835W1_2110">
    <xs:annotation>
      <xs:appinfo>
        <b:recordInfo trigger_field="REF01__ReferenceIdentificationQualifier" trigger_value="1S 6R BB E9 G1 G3 LU RB" tag_name="REF_ServiceIdentification_TS835W1_2110" structure="delimited" delimiter_type="inherit_field" field_order="prefix" count_ignore="no" child_delimiter="default" notes="Service Identification">
          <b:Rule subjects="X12ConditionDesignatorX_Required">
            <b:Subject name="REF02__ProviderIdentifier" />
            <b:Subject name="REF03" />
          </b:Rule>
        </b:recordInfo>
      </xs:appinfo>
    </xs:annotation>
    <xs:complexType>
      <xs:sequence>
        <xs:element name="REF01__ReferenceIdentificationQualifier">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="ID" justification="left" codelist="128" sequence_number="01">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_ID">
              <xs:enumeration value="1S" />
              <xs:enumeration value="6R" />
              <xs:enumeration value="BB" />
              <xs:enumeration value="E9" />
              <xs:enumeration value="G1" />
              <xs:enumeration value="G3" />
              <xs:enumeration value="LU" />
              <xs:enumeration value="RB" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element name="REF02__ProviderIdentifier">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="AN" justification="left" sequence_number="02">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_AN">
              <xs:minLength value="1" />
              <xs:maxLength value="30" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="REF03">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="AN" justification="left" sequence_number="03">
              </b:fieldInfo>
              <wpc:Info NotUsed="true" />
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_AN">
              <xs:minLength value="1" />
              <xs:maxLength value="80" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="REF04_C040U805">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="AN" sequence_number="04">
              </b:fieldInfo>
              <wpc:Info NotUsed="true" />
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_AN">
              <xs:minLength value="1" />
              <xs:maxLength value="1" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
      </xs:sequence>
    </xs:complexType>
  </xs:element>
  <xs:element name="REF_RenderingProviderInformation_TS835W1_2110">
    <xs:annotation>
      <xs:appinfo>
        <b:recordInfo trigger_field="REF01__ReferenceIdentificationQualifier" trigger_value="1A 1B 1C 1D 1G 1H 1J HPI SY TJ" tag_name="REF_RenderingProviderInformation_TS835W1_2110" structure="delimited" delimiter_type="inherit_field" field_order="prefix" count_ignore="no" child_delimiter="default" notes="Rendering Provider Information">
          <b:Rule subjects="X12ConditionDesignatorX_Required">
            <b:Subject name="REF02__RenderingProviderIdentifier" />
            <b:Subject name="REF03" />
          </b:Rule>
        </b:recordInfo>
      </xs:appinfo>
    </xs:annotation>
    <xs:complexType>
      <xs:sequence>
        <xs:element name="REF01__ReferenceIdentificationQualifier">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="ID" justification="left" codelist="128" sequence_number="01">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_ID">
              <xs:enumeration value="1A" />
              <xs:enumeration value="1B" />
              <xs:enumeration value="1C" />
              <xs:enumeration value="1D" />
              <xs:enumeration value="1G" />
              <xs:enumeration value="1H" />
              <xs:enumeration value="1J" />
              <xs:enumeration value="HPI" />
              <xs:enumeration value="SY" />
              <xs:enumeration value="TJ" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element name="REF02__RenderingProviderIdentifier">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="AN" justification="left" sequence_number="02">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_AN">
              <xs:minLength value="1" />
              <xs:maxLength value="30" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="REF03">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="AN" justification="left" sequence_number="03">
              </b:fieldInfo>
              <wpc:Info NotUsed="true" />
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_AN">
              <xs:minLength value="1" />
              <xs:maxLength value="80" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="REF04_C040U806">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="AN" sequence_number="04">
              </b:fieldInfo>
              <wpc:Info NotUsed="true" />
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_AN">
              <xs:minLength value="1" />
              <xs:maxLength value="1" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
      </xs:sequence>
    </xs:complexType>
  </xs:element>
  <xs:element name="AMT_ServiceSupplementalAmount_TS835W1_2110">
    <xs:annotation>
      <xs:appinfo>
        <b:recordInfo tag_name="AMT_ServiceSupplementalAmount_TS835W1_2110" structure="delimited" delimiter_type="inherit_field" field_order="prefix" count_ignore="no" child_delimiter="default" notes="Service Supplemental Amount" />
      </xs:appinfo>
    </xs:annotation>
    <xs:complexType>
      <xs:sequence>
        <xs:element name="AMT01__AmountQualifierCode">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="ID" justification="left" codelist="522" sequence_number="01">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_ID">
              <xs:enumeration value="B6" />
              <xs:enumeration value="DY" />
              <xs:enumeration value="KH" />
              <xs:enumeration value="NE" />
              <xs:enumeration value="T" />
              <xs:enumeration value="ZK" />
              <xs:enumeration value="ZL" />
              <xs:enumeration value="ZM" />
              <xs:enumeration value="ZN" />
              <xs:enumeration value="ZO" />
              <xs:enumeration value="T2" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element name="AMT02__ServiceSupplementalAmount">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo custom_maxlength="18" edi_datatype="R" justification="right" sequence_number="02">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_R" />
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="AMT03">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="ID" sequence_number="03">
              </b:fieldInfo>
              <wpc:Info NotUsed="true" />
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_ID">
              <xs:minLength value="1" />
              <xs:maxLength value="1" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
      </xs:sequence>
    </xs:complexType>
  </xs:element>
  <xs:element name="QTY_ServiceSupplementalQuantity_TS835W1_2110">
    <xs:annotation>
      <xs:appinfo>
        <b:recordInfo tag_name="QTY_ServiceSupplementalQuantity_TS835W1_2110" structure="delimited" delimiter_type="inherit_field" field_order="prefix" count_ignore="no" child_delimiter="default" notes="Service Supplemental Quantity">
          <b:Rule subjects="X12ConditionDesignatorX_Required">
            <b:Subject name="QTY02__ServiceSupplementalQuantityCount" />
            <b:Subject name="QTY04" />
          </b:Rule>
          <b:Rule subjects="X12ConditionDesignatorX_Exclusion">
            <b:Subject name="QTY02__ServiceSupplementalQuantityCount" />
            <b:Subject name="QTY04" />
          </b:Rule>
        </b:recordInfo>
      </xs:appinfo>
    </xs:annotation>
    <xs:complexType>
      <xs:sequence>
        <xs:element name="QTY01__QuantityQualifier">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="ID" codelist="673" sequence_number="01">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_ID">
              <xs:enumeration value="NE" />
              <xs:enumeration value="ZK" />
              <xs:enumeration value="ZL" />
              <xs:enumeration value="ZM" />
              <xs:enumeration value="ZN" />
              <xs:enumeration value="ZO" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element name="QTY02__ServiceSupplementalQuantityCount">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo custom_maxlength="15" edi_datatype="R" justification="right" sequence_number="02">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_R" />
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="QTY03_C001U807">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="AN" sequence_number="03">
              </b:fieldInfo>
              <wpc:Info NotUsed="true" />
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_AN">
              <xs:minLength value="1" />
              <xs:maxLength value="1" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" name="QTY04">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="AN" justification="left" sequence_number="04">
              </b:fieldInfo>
              <wpc:Info NotUsed="true" />
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_AN">
              <xs:minLength value="1" />
              <xs:maxLength value="30" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
      </xs:sequence>
    </xs:complexType>
  </xs:element>
  <xs:element name="LQ_HealthCareRemarkCodes_TS835W1_2110">
    <xs:annotation>
      <xs:appinfo>
        <b:recordInfo tag_name="LQ_HealthCareRemarkCodes_TS835W1_2110" structure="delimited" delimiter_type="inherit_field" field_order="prefix" count_ignore="no" child_delimiter="default" notes="Health Care Remark Codes">
          <b:Rule subjects="X12ConditionDesignatorX_Conditional" qualifier="LQ01__CodeListQualifierCode">
            <b:Subject name="LQ02__RemarkCode" />
          </b:Rule>
        </b:recordInfo>
      </xs:appinfo>
    </xs:annotation>
    <xs:complexType>
      <xs:sequence>
        <xs:element name="LQ01__CodeListQualifierCode">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="ID" justification="left" codelist="1270" sequence_number="01">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_ID">
              <xs:enumeration value="HE" />
              <xs:enumeration value="RX" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element name="LQ02__RemarkCode">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="AN" justification="left" sequence_number="02">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_AN">
              <xs:minLength value="1" />
              <xs:maxLength value="30" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
      </xs:sequence>
    </xs:complexType>
  </xs:element>
  <xs:element name="PLB_ProviderAdjustment_TS835W1">
    <xs:annotation>
      <xs:appinfo>
        <b:recordInfo tag_name="PLB_ProviderAdjustment_TS835W1" structure="delimited" child_delimiter="default" delimiter_type="inherit_field" field_order="prefix" count_ignore="no" subdocument_creation_break="yes" notes="Provider Adjustment">
          <b:Rule subjects="X12ConditionDesignatorX_Paired">
            <b:Subject name="PLB05_C042U811_TS835W1" />
            <b:Subject name="PLB06__ProviderAdjustmentAmount" />
          </b:Rule>
          <b:Rule subjects="X12ConditionDesignatorX_Paired">
            <b:Subject name="PLB07_C042U814_TS835W1" />
            <b:Subject name="PLB08__ProviderAdjustmentAmount" />
          </b:Rule>
          <b:Rule subjects="X12ConditionDesignatorX_Paired">
            <b:Subject name="PLB09_C042U817_TS835W1" />
            <b:Subject name="PLB10__ProviderAdjustmentAmount" />
          </b:Rule>
          <b:Rule subjects="X12ConditionDesignatorX_Paired">
            <b:Subject name="PLB11_C042U820_TS835W1" />
            <b:Subject name="PLB12__ProviderAdjustmentAmount" />
          </b:Rule>
          <b:Rule subjects="X12ConditionDesignatorX_Paired">
            <b:Subject name="PLB13_C042U823_TS835W1" />
            <b:Subject name="PLB14__ProviderAdjustmentAmount" />
          </b:Rule>
        </b:recordInfo>
      </xs:appinfo>
    </xs:annotation>
    <xs:complexType>
      <xs:sequence>
        <xs:element name="PLB01__ProviderIdentifier">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="AN" justification="left" sequence_number="01">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_AN">
              <xs:minLength value="1" />
              <xs:maxLength value="30" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element name="PLB02__FiscalPeriodDate">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo edi_datatype="DT" format="YYYYMMDD" sequence_number="02">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_DT">
              <xs:minLength value="8" />
              <xs:maxLength value="8" />
            </xs:restriction>
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="1" maxOccurs="1" ref="PLB03_C042U808_TS835W1" />
        <xs:element name="PLB04__ProviderAdjustmentAmount">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo custom_maxlength="18" edi_datatype="R" justification="right" sequence_number="04">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_R" />
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" maxOccurs="1" ref="PLB05_C042U811_TS835W1" />
        <xs:element minOccurs="0" name="PLB06__ProviderAdjustmentAmount">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo custom_maxlength="18" edi_datatype="R" justification="right" sequence_number="06">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_R" />
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" maxOccurs="1" ref="PLB07_C042U814_TS835W1" />
        <xs:element minOccurs="0" name="PLB08__ProviderAdjustmentAmount">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo custom_maxlength="18" edi_datatype="R" justification="right" sequence_number="08">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_R" />
          </xs:simpleType>
        </xs:element>
        <xs:element minOccurs="0" maxOccurs="1" ref="PLB09_C042U817_TS835W1" />
        <xs:element minOccurs="0" name="PLB10__ProviderAdjustmentAmount">
          <xs:annotation>
            <xs:appinfo>
              <b:fieldInfo custom_maxlength="18" edi_datatype="R" justification="right" sequence_number="10">
              </b:fieldInfo>
            </xs:appinfo>
          </xs:annotation>
          <xs:simpleType>
            <xs:restriction base="X12_R" />
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        </xs:element>
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